腹腔镜与开腹肝切除手术治疗特殊部位肝细胞癌的临床疗效分析

Perioperative and long-term outcomes of laparoscopic versus open hepatectomy for hepatocellular carcinoma at specific sites of liver

目的比较腹腔镜与开腹肝切除手术在特殊部位肝细胞癌治疗中的临床疗效。方法回顾性分析2014年9月至2019年5月福建医科大学孟超肝胆医院接受肝切除术的特殊部位肝细胞癌(位于肝Ⅰ、Ⅶ、Ⅷ、Ⅵa段)患者资料。共纳入205例肝细胞癌患者,其中男性174例,女性31例,年龄(56.7±11.3)岁。依据肝切除手术方式不同分为腹腔镜组(n=105)和开腹组(n=100)。比较两组术前肝功能Child-Pugh分级、肿瘤最大径、肿瘤位置、术中出血量、术后并发症发生率、肝功能(丙氨酸氨基转移酶、天冬氨酸氨基转移酶等)、住院时间等。随访术后生存和复发情况。Kaplan-Meier法绘制生存曲线,log-rank检验比较生存率。结果两组患者肝功能Child-Pugh分级、肿瘤最大径、肿瘤位置等术前资料比较,差异均无统计学意义(均P>0.05)。腹腔镜组术中出血量100(50,200)ml、术后并发症发生率7.6%(8/105)、住院时间(8.6±1.9)d,低于开腹组150(100,200)ml、17.0%(17/100)、(13.0±3.4)d,差异均有统计学意义(均P<0.05)。腹腔镜组术后丙氨酸氨基转移酶、天冬氨酸氨基转移酶低于开腹组,差异均有统计学意义(均P<0.05)。两组术后1、3、5年累积生存率和无复发生存率比较,差异均无统计学意义(χ^(2)=0.56、0.21,P=0.456、0.648)。结论与开腹手术相比,特殊部位肝细胞癌患者腹腔镜肝切除有更好短期疗效,术中出血量更少,住院时间更短,术后并发症发生率更低,远期疗效相当。

Objective To compare the clinical efficacy of laparoscopic and open surgery in the treatment of hepatocellular carcinoma(HCC)at specific sites of liver.Methods Data of patients with HCC undergoing hepatectomy in Mengchao Hepatobiliary Hospital of Fujian Medical University from September 2014 to May 2019 were retrospective analyzed.A total of 205 patients were enrolled,including 174 males and 31 females,aged(56.7±11.3)years.According to the surgical methods,patients were divided into laparoscopic group(n=105)and open group(n=100).The Child-Pugh score,maximum tumor diameter,tumor location,intraoperative blood loss,postoperative complication rate,liver function(glutamate transaminase,alanine transaminase,etc.)and length of hospital stay were compared between the two groups.Postoperative survival and recurrence were followed up.Survival curves and rates were analyzed by Kaplan-Meier and log-rank test.Results There were no significant differences in Child-Pugh score,maximum tumor diameter,tumor location between the two groups.Compared to the open group,the laparoscopic group had a decreased blood loss[100(50,200)ml vs 150(100,200)ml],a lower incidence of postoperative complications[7.6%(8/105)vs 17.0%(17/100)],and a shorter hospital stay[(8.6±1.9)days vs(13.0±3.4)days](all P<0.05).The postoperative glutamate transaminase and alanine transaminase levels were lower in the laparoscopic group than those in the open group.The 1,3,5-year overall survival and recurrence-free survival were not significantly different between the two groups(χ^(2)=0.56,0.21,P=0.456,0.648).ConclusionLaparoscopic surgery in the treatment of HCC at specific sites of liver is a safe,feasible and effective procedure.