腹腔镜下背腹侧结合路径解剖性肝S7段切除术治疗肝细胞癌的临床分析

Clinical analysis of laparoscopic anatomical hepatectomy of segment VII for hepatocellular carcinoma with dorsal-ventral combined approach

目的探讨腹腔镜下背腹侧结合路径解剖性肝S7段切除术在治疗肝细胞癌中的临床应用价值。方法回顾性分析2020年12月至2023年4月在江南大学附属医院肝胆外科接受腹腔镜下背腹侧结合路径解剖性肝S7段切除术的23例肝细胞癌患者的临床资料,其中男性11例,女性12例,年龄(58.5±7.9)岁。总结分析患者的手术情况、术后并发症和随访情况。结果23例患者手术均顺利完成,无中转开腹者。手术时间为(286.7±63.4)min,术中出血量200(150,400)ml,均未输血。术后无腹腔出血、胆漏、肝功能衰竭、腹腔感染等严重并发症发生,2例患者术后右侧胸腔积液,行穿刺引流后治愈。患者术后第2天均可下床活动,术后住院时间为(9.36±1.72)d。病灶长径为(4.38±1.42)cm。患者术后3个月复查甲胎蛋白为(3.26±0.93)ng/ml,与术前(46.75±9.43)ng/ml相比差异有统计学意义(t=38.24,P=0.008)。术后随访过程中检查甲胎蛋白均正常,MRI检查未发现肿瘤复发转移。结论腹腔镜下背腹侧结合路径解剖性肝S7段切除术治疗肝细胞癌具有临床实用性,值得推广。

ObjectiveTo study the feasibility of laparoscopic anatomical hepatectomy of segment VII for hepatocellular carcinoma(HCC)with dorsal-ventral combined approach.MethodsClinical data of 23 patients with HCC undergoing laparoscopic anatomical hepatectomy of segment VII with dorsal-ventral combined approach in Jiangnan University Affiliated Hospital from December 2020 to April 2023 were retrospectively collected,including 11 males and 12 females,aged(58.5±7.9)years old.The patient's perio-perative data,postoperative complications,and follow-ups were analyzed.ResultsAll patients underwent the surgery successfully without conversion to laparotomy.The operation time was(286.7±63.4)min,the amount of intraoperative blood loss[M(Q 1,Q 3)]was 200(150,400)ml without blood transfusion.There were no major complications such as abdominal bleeding,bile leakage,liver failure or abdominal infection.Two cases had right pleural effusion and were managed with thoracic drainage.The patients could ambulate on postoperative day 2,and the postoperative hospital stay was(9.36±1.72)d.The diameter of the lesion was(4.38±1.42)cm.The serum level of alpha fetoprotein(AFP)three months after surgery was(3.26±0.93)ng/ml,lower than the preoperative baseline(46.75±9.43)ng/ml(t=38.24,P=0.008).All patients showed normal serum levels of AFP and there were no tumor recurrence or metastasis during postoperative follow-ups.ConclusionLaparoscopic anatomical hepatectomy of segment VII for HCC with dorsal-ventral combined approach is feasible and worth spreading.