腹腔镜与开腹肝部分切除术治疗肝细胞癌临床疗效比较

Clinical comparative study of laparoscopic hepatectomy versus open hepatectomy for the treatment of hepatocellular carcinoma

目的探讨腹腔镜与开腹肝部分切除术治疗肝细胞癌的临床疗效及安全性。方法选取2008年1月至2013年6月成都市第三人民医院收治手术治疗的原发性肝细胞癌患者84例为研究对象,其中腹腔镜下肝癌肝部分切除术者41例(腹腔镜组),开腹肝癌肝部分切除术者43例(开腹组),比较两组患者的手术时间、术中出血量、术后住院时间、手术费用及术后生存率。结果腹腔镜组手术时间明显长于开腹组[(88.54±28.32)min vs(59.24±19.52)min],住院时间明显短于开腹组[(13.23±3.65)d vs(17.21±6.45)d],差异均有统计学意义(P<0.05);而术中失血量[(502.66±105.32)m L vs(479.63±112.16)m L]、肝门阻断时间[(22.36±10.32)min vs(19.36±11.45)min]、住院费用[(3.45±0.21)万元vs(3.39±0.23)万元]和并发症[9.8%(4/41)vs 9.3%(4/43)]比较差异均无统计学意义(P>0.05);腹腔镜组1年和2年生存率为88.1%和76.1%,开腹组为90.0%和72.5%,两组1年和2年生存率比较差异均无统计学意义(P>0.05);腹腔镜组中位生存时间为50.2个月,开腹为46.5个月,两组患者中位生存时间比较差异无统计学意义(P>0.05)。结论腹腔镜治疗原发性肝细胞癌创伤小,术后恢复快,但手术时间较长。

Objective To evaluate the clinical efficacy and safety of laparoscopic versus open hepatectomy in the treatment of hepatocellular carcinoma(HCC). Methods Eighty-four patients of primary HCC, who admitted to the Third People’s Hospital of Chengdu from January 2008 to June 2013, were analyzed in this study. Of these, 41 patientswere treated by laparoscopic hepatectomy(laparoscopic hepatectomy group), and other 43 patients were treated by open hepatectomy(open hepatectomy group). The operation time, blood loss, length of hospital stay, hospitalization expenses,complications and median survival time of the two groups were compared. Results The operation time of laparoscopic hepatectomy group was significantly longer than open hepatectomy group [(88.54±28.32) min vs(59.24±19.52) min, P<0.05], while the length of hospital stay in laparoscopic hepatectomy group was significantly shorter than open hepatectomy group [(13.23±3.65) days vs(17.21±6.45) days, P<0.05]. The blood loss [(502.66±105.32) m L vs(479.63±112.16) m L],pringle’s manoeuver time [(22.36 ± 10.32) min vs(19.36 ± 11.45) min], hospitalization expenses [(3.45 ± 0.21) × 105$ vs(3.39±0.23)×105$] and complication incidence [9.8%(4/41) vs 9.3%(4/43)] of the two groups had no significant differences(P>0.05). The 1-year and 2-year survival rates in the laparoscopic hepatectomy group and open hepatectomy group were respectively 88.1% and 76.1% versus 90.0% and 72.5%, with no significant difference(P>0.05). The median survival time of the laparoscopic hepatectomy group and open hepatectomy group were respectively 50.2 months and46.5 months, with no significant difference(P>0.05). Conclusion Laparoscopic hepatectomy had the advantages of minimal trauma and rapid postoperative recovery, but the operation time was relatively long for the treatment of HCC.