腹腔镜限量解剖性肝切除术治疗右前区肝细胞癌的倾向性评分匹配研究

Laparoscopic limited anatomical hepatectomy for hepatocellular carcinoma within the right anterior section:a propensity score matched study

目的探究腹腔镜限量解剖性肝切除术(LLAH)治疗右前区肝细胞癌的效果。方法回顾分析陆军军医大学第一附属医院2015年1月至2022年12月行腹腔镜肝切除的右前区肝细胞癌患者资料。共入组144例患者,其中男性122例,女性22例,年龄(54.5±9.7)岁。依据手术方式不同,144例患者分为LLAH组(n=27)、腹腔镜解剖性肝切除术(LAH)组(n=69)、腹腔镜非解剖性肝切除术(LNAH)组(n=48)。采用倾向性评分匹配,比较匹配后两组手术时间、术后住院时间、术后并发症、总胆红素、白蛋白等指标以及无瘤生存率、累积生存率等预后指标。结果倾向性评分匹配后,LLAH组与LNAH组各26例。匹配后LLAH组与LNAH组手术时间、术中出血量、术后住院时间等比较,差异均无统计学意义(均P>0.05)。LLAH组术后第3天总胆红素[M(Q_(1),Q_(3))]24.1(20.9,29.1)μmol/L、白蛋白(35.8±2.9)g/L,优于LNAH组[M(Q 1,Q 3)]39.3(33.2,57.0)μmol/L、(33.9±2.5)g/L,LLAH组术后1、3年无瘤生存率分别为92.3%、57.7%,优于LNAH组的80.8%、19.2%,差异均有统计学意义(均P<0.05)。倾向性评分匹配后,LLAH组与LAH组各25例。匹配后LLAH组手术时间、术后住院时间、术后并发症发生率低于LAH组,术后肝功能优于LAH组,差异均有统计学意义(均P<0.05)。LLAH组与LAH组无瘤生存率比较,差异无统计学意义(χ^(2)=0.10,P=0.800)。结论LLAH治疗右前区肝细胞癌的围手术期效果与LNAH相似、优于LAH,而LLAH治疗右前区肝细胞癌的无瘤生存率则优于LNAH、与LAH相似。

Objective To study the efficacy of laparoscopic limited anatomical hepatectomy(LLAH)for hepatocellular carcinoma(HCC)within the right anterior section.Methods The clinical data of 144 patients with HCC confined in the right anterior section undergoing hepatectomy at the First Affiliated Hospital of Army Medical University from January 2015 to December 2022 were retrospectively analyzed,including 122 males and 22 females,aged(54.5±9.7)years.Patients were divided into LLAH(n=27),laparoscopic anatomical hepatectomy(LAH,n=69),and laparoscopic non-anatomical hepatectomy(LNAH,n=48).Propensity score matching was used to compare the operative time,postoperative hospital stay,postoperative complications,serum total bilirubin and albumin,and the prognostic indicators such as tumor-free survival(DFS)rate and cumulative survival rate between the groups.Results After propensity score matching,there were 26 cases each in LLAH and LNAH group.There was no significant difference in operative time,intraoperative blood loss and postoperative hospital stay between LLAH group and LNAH group(all P<0.05).The total bilirubin and albumin in LLAH on the third day after operation were[M(Q_(1),Q_(3))]24.1(20.9,29.1)μmol/L and(35.8±2.9)g/L,better than those in LNAH group 39.3(33.2,57.0)μmol/L and(33.9±2.5)g/L,respectively.The 1-and 3-year DFS rates in LLAH group were 92.3%and 57.7%,higher than those in LNAH group(80.8%and 19.2%)(all P<0.05).After propensity score matching,there were 25 patients each in LLAH and LAH group.The operative time,postoperative hospital stay and postoperative complications of LLAH group were lower than those of LAH group,and the liver function parameters of LLAH group was also better than those of LAH group(all P<0.05).There was no significant difference in DSF rate between the two groups LLAH group and LAH group(χ^(2)=0.10,P=0.800).Conclusions The perioperative outcome of LLAH for HCC within the right anterior section are similar to that of LNAH and better than that of LAH.The DFS of LLAH were better than that of LNAH and similar to that of LAH.