腹腔镜解剖性肝右后区联合右前区背侧段切除术治疗肝细胞癌的临床疗效

Clinical efficacy of laparoscopic anatomical right posterior sector combined with anterior-dorsal segment resection for hepatocellular carcinoma

目的探讨腹腔镜解剖性肝右后区联合右前区背侧段切除术治疗肝细胞癌的临床疗效。方法采用回顾性描述性研究方法。收集2020年9月至2021年8月中山大学孙逸仙纪念医院收治的15例行腹腔镜解剖性肝右后区联合右前区背侧段切除术治疗肝细胞癌患者的临床病理资料;男9例,女6例;年龄为66(35~77)岁。观察指标:(1)手术情况。(2)术后情况。(3)随访情况。采用门诊和电话方式进行术后90 d随访,了解患者肿瘤复发情况和生存情况。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数表示。结果(1)手术情况。15例患者均顺利完成腹腔镜解剖性肝右后区联合右前区背侧段切除术,术中均未输血,无中转开腹。15例患者手术时间为(155±17)min,术中出血量为(254±66)mL,术中第一肝门阻断时间为(51±7)min。(2)术后情况。15例患者术后住院时间为(7.4±2.1)d。15例患者术后组织病理学检查结果显示均为肝细胞癌,标本切缘均为阴性,最小切缘距肿瘤距离为(1.5±0.8)cm。15例患者无术后转入重症监护室、住院期间死亡及30 d内再住院。15例患者中,2例出现术后并发症,胆瘘(Clavien‑DindoⅠ级)和腹水(Clavien‑DindoⅡ级)各1例,经冲洗引流、腹腔穿刺引流后好转。(3)随访情况。15例患者均获得术后90 d随访。随访期间,所有患者未出现肿瘤复发;无术后90 d死亡患者。结论腹腔镜解剖性肝右后区联合右前区背侧段切除术治疗肝细胞癌安全、可行。

Objective To investigate the clinical efficacy of laparoscopic anatomical right posterior sector combined with anterior-dorsal segment resection for hepatocellular carcinoma.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 15 patients with hepatocellular carcinoma who underwent laparoscopic anatomical right posterior sector combined with anterior-dorsal segment resection in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from September 2020 to August 2021 were collected.There were 9 males and 6 females,aged 66(range,35‒77)years.Observation indicators:(1)surgical situations;(2)postoperative situations;(3)follow-up.Follow-up was conducted using outpatient examination and telephone interview to detect tumor recurrence and survival of patients in the postoperative 90 ays.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers.Results(1)Surgical situations.All the 15 patits underwent laparoscopic anatomical right posterior sector combined with anterior-dorsal segment resection successfully,without blood transfusion and conversion to laparotomy during the operation.The operation time,volume of intraoperative blood loss and occlusion time of first porta hepatis of the 15 patients were(155±17)minutes,(254±66)mL and(51±7)minutes,respectively.(2)Postoperative situations.The duration of postoperative hospital stay of the 15 patients was(7.4±2.1)days.Results of postoperative histopathological examination showed hepatocellular carcinoma and R 0 margins in all the 15 patie with a minimum distance from margin to tumor of(1.5±0.8)cm.There was none of the 15 patients transferred to intensive care unit,perioperative death or rehospitalization within 30 days after surgery.Of the 15 patients,2 cases had postoperative complications,including 1 case with biliary fistula(gradeⅠof Clavien-Dindo classification)and 1 case with ascites(gradeⅡof Clavien-Dindo classification).Patients with complications were improved after washing and drainage,abdominal puncture and drainage.(3)Follow-up.All the 15 patients were followed up for the postoperative 90 days and none of them had tumor recurrence death within postoperative 90 days.Conclusion The laparoscopic anatomical right posterior sector and anterior-dorsal segment resec-tion for hepatocellular carcinoma is safe and feasible.