两种腹腔镜肝切除手术治疗原发性肝癌的比较

Comparison of two different laparoscopic hepatectomy for the treatment of primary liver cancer

目的比较微波消融辅助腹腔镜肝切除与单纯腹腔镜肝切除治疗肝癌的临床疗效。方法回顾性分析2013年1月至2016年6月在中国医科大学附属盛京医院行腹腔镜肝切除手术的70例原发性肝癌临床资料,将其分为微波消融辅助腹腔镜肝切除组(微波辅助组,n=40)和单纯腹腔镜肝切除组(单纯切除组,n=30)。比较两组的临床疗效及预后。结果两组手术时间、术后住院时间、术后进食时间、术后切缘复发情况及术后肝功能指标比较均无统计学差异(P> 0. 05)。微波辅助组术中出血量显著低于对照组[(36. 2±12. 3) ml vs (186. 7±16. 2) ml,P <0. 01],术后拔管时间显著短于对照组[(3. 3±1. 0) d vs (5. 2±1. 3) d,P <0. 01]。微波辅助组和单纯切除组术后1年、2年的无瘤生存率比较无统计学差异(89. 4%vs 87. 8%,65. 5%vs 42. 8%,P> 0. 05)。微波辅助组术后1年、2年的总体生存率高于单纯切除组(100%vs 91. 7%,90. 9%vs 68. 8%,P <0. 05)。结论微波消融辅助腹腔镜肝切除相比于单纯腹腔镜肝切除治疗肝癌术中出血更少、更安全,预后更好。

Objective To compare the efficacy of microwave ablation-assisted laparoscopic hepatectomy and laparoscopic hepatectomy alone for the treatment of primary liver cancer. Methods The clinical data of 70 patients with liver cancer underwent laparoscopic hepatectomy in Shengjing Hospital Affiliated to China Medical University from January 2013 to June2016 were retrospectively analyzed. The patients were divided into microwave ablation-assisted laparoscopic hepatectomy group( microwave-assisted group,40 cases) and simple laparoscopic hepatectomy group( simple resection group,30 cases). The clinical efficacy and prognosis were compared between two groups. Results Intraoperative blood loss in microwave-assisted group lower than simple resection group [( 36. 2 ± 12. 3) ml vs( 186. 7 ± 16. 2) ml,P < 0. 01].Postoperative extubation time in microwave-assisted group lower than simple resection group (( 3. 3 ± 1. 0) d vs( 5. 2 ±1. 3) d,P < 0. 01)There were no significant differences in 1-and 2-year tumor-free survival rates between microwaveassisted group and simple resection group( 89. 4% vs 87. 8%,65. 5% vs 42. 8%,all P > 0. 05). There were significant differences in 1-and 2-year overall survival rates between microwave-assisted group and simple resection group( 100% vs91. 7%,90. 9% vs 68. 8%,all P < 0. 05). Conclusion Compared with simple laparoscopic hepatectomy,microwave ablation-assisted laparoscopic hepatectomy has the advantages of less bleeding,safer and better prognosis for the treatment of liver cancer.