乙型肝炎相关性肝细胞癌腹腔镜手术安全性分析

Safety analysis of laparoscopy for hepatitis B-related hepatocellular carcinoma

目的探讨腹腔镜手术和开腹手术在乙型肝炎相关性肝细胞癌手术中的安全性。方法回顾性分析中国科学技术大学附属第一医院2019年1月至2021年12月期间采用外科手术切除的103例肝细胞癌且患有乙型肝炎病人的资料。根据手术方式的不同分为腹腔镜组和开腹组,分析病人的手术时间、围术期输血量、手术切除范围及并发症发生率等资料。结果103例病人均成功施行了肝切除手术,其中开腹手术50例,腹腔镜手术53例。通过1∶1倾向性评分匹配后各收集腹腔镜组病人30例和开腹组病人30例基线资料情况。匹配后,两组病人基线资料比较差异均无统计学意义(均P>0.05)。术中情况:腹腔镜组与开腹组相比,手术时间、术中阻断时间、术中输血量、术中阻断次数差异均无统计学意义(均P>0.05),而两组术中肝切除范围差异有统计学意义[大范围肝切除占比:13.3%(4/30)比46.7%(14/30),P=0.005],术中出血量差异有统计学意义[(132.3±118.5)mL比(238.3±184.1)mL,P=0.010]。术后情况:两组术后输血量以及术后并发症(腹腔出血、肺部感染、胸腔积液、腹腔积液、肝切除术后肝衰竭等)差异均无统计学意义(均P>0.05);两组术后住院时间比较,差异有统计学意义[(8.8±4.1)d比(11.0±4.4)d,P=0.047]。结论腹腔镜肝切除术治疗乙型肝炎相关性肝细胞癌安全可靠。

Objective To explore the safety of laparoscopy versus open surgery for hepatitis B related hepatocellular carcinoma(HCC).Methods The relevant clinical data of 103 HCC patients with hepatitis B operated from January 2019 to December 2021 were reviewed retrospectively.According to different operative approaches,they were divided into two groups of laparoscopy(n=53)and open surgery(n=50).Results Hepatectomy was successfully performed.Baseline profiles were collected from 30 patients in laparoscopic group and 30 patients in open group by matching a 1∶1 propensity score.After propensity score matching for both groups,there was no statistically significant difference in baseline profiles(P>0.05).Inter-group differences in operative duration,intraoperative blocking time,intraoperative blood transfusion and number of intraoperative blockage were not statistically significant(P>0.05);statistically significant inter-group differences existed in extent of intraoperative liver resection[13.3%(4/30)vs.46.7%(14/30),P=0.005]and intraoperative hemorrhage[(132.3±118.5)vs.(238.3±184.1)mL,P=0.010];Inter-group differences were not statistically significant in postoperative blood transfusion and postoperative complications(abdominal hemorrhage,pulmonary infection,pleural effusion,peritoneal effusion,liver failure after hepatectomy,etc.)(P>0.05);inter-group difference was statistically significant in postoperative hospitalization duration[(8.8±4.1)vs.(11.0±4.4)days,P=0.047].Conclusion Laparoscopic hepatectomy is both safe and reliable for hepatitis B related HCC.