腹腔镜非解剖性肝切除术治疗原发性肝癌的临床疗效分析
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摘要
目的探讨腹腔镜非解剖性肝切除术治疗原发性肝癌的临床疗效。方法回顾性分析2013年2月至2017年5月安康市中心医院收治的72例原发性肝癌病人,按局部性肝切除术实施手术,依据手术方式的选择分为腹腔镜组与开腹组,其中腹腔镜组34例,开腹组38例。比较两组病人的相关临床指标、并发症及疗效。结果腹腔镜组与开腹组比较,手术时间(132.47 min比176.13 min)、术中出血量(226.24 ml比380.06 ml)、胃肠道恢复时间(1.63 d比2.84 d)、术后拔除引流管时间(4.82 d比6.25 d)、住院时间(8.07 d比12.33 d)明显减少,但住院费用(4.88万元比4.20万元)增加,差异均有统计学意义(均P<0.05);总并发症发生率(11.8%比34.2%)、肝功能Child-Pugh B级(2.9%比21.1%)明显降低(均P<0.05);术后随访,腹腔镜组总的复发或转移率(17.6%比21.1%)、术后1年生存率(91.5%比89.5%)、累积生存率比较,差异均无统计学意义(均P>0.05)。结论腹腔镜非解剖性肝切除术在治疗原发性肝癌病人中具有恢复快、并发症低、住院时间短的优点,远期能保持与开腹手术类似的疗效,充分体现了腹腔镜微创手术的优势。
Objective To explore the clinical efficacy of laparoscopic non-anatomical hepatectomy in the treatment of patients with primary liver cancer.Methods A retrospective analysis was performed on 72 patients with primary liver cancer admitted to Ankang Central Hospital from February 2013 to May 2017.They were divided into laparoscopy group and laparotomy group according to the choice of surgical methods, including 34 cases in laparoscopy group and 38 cases in laparotomy group.The clinical indicators, complications and curative effects of the two groups were compared.Results Compared with laparotomy group, the operation time(132.47 min vs.176.13 min), intraoperative bleeding volume(226.24 ml vs.380.06 ml), gastrointestinal recovery time(1.63 d vs.2.84 d), postoperative drainage time(4.82 d vs.6.25 d) and hospitalization time(8.07 d vs.12.33 d) in laparoscopic group were significantly shortened, but the hospitalization cost(48 800 yuan vs.42 000 yuan) was significantly reduced.The incidence of total complications(11.8% vs.34.2%) and grade B liver function(2.9% vs.21.1%) in laparoscopic group were significantly decreased as compared with that in laparotomy group(both P<0.05).There was no significant difference in the total recurrence or metastasis rate(17.6% vs.21.1%), one-year survival rate(91.5% vs.89.5%), and cumulative survival rate between laparotomy group and laparoscopic group(all P>0.05).Conclusion Laparoscopic non-anatomical hepatectomy has the advantages of quick recovery, little complications and short hospitalization time in the treatment of patients with primary liver cancer.It can maintain the long-term curative effect similar to that of open hepatectomy, which fully reflects the advantages of laparoscopic minimally invasive surgery.
Objective To explore the clinical efficacy of laparoscopic non-anatomical hepatectomy in the treatment of patients with primary liver cancer.Methods A retrospective analysis was performed on 72 patients with primary liver cancer admitted to Ankang Central Hospital from February 2013 to May 2017.They were divided into laparoscopy group and laparotomy group according to the choice of surgical methods, including 34 cases in laparoscopy group and 38 cases in laparotomy group.The clinical indicators, complications and curative effects of the two groups were compared.Results Compared with laparotomy group, the operation time(132.47 min vs.176.13 min), intraoperative bleeding volume(226.24 ml vs.380.06 ml), gastrointestinal recovery time(1.63 d vs.2.84 d), postoperative drainage time(4.82 d vs.6.25 d) and hospitalization time(8.07 d vs.12.33 d) in laparoscopic group were significantly shortened, but the hospitalization cost(48 800 yuan vs.42 000 yuan) was significantly reduced.The incidence of total complications(11.8% vs.34.2%) and grade B liver function(2.9% vs.21.1%) in laparoscopic group were significantly decreased as compared with that in laparotomy group(both P<0.05).There was no significant difference in the total recurrence or metastasis rate(17.6% vs.21.1%), one-year survival rate(91.5% vs.89.5%), and cumulative survival rate between laparotomy group and laparoscopic group(all P>0.05).Conclusion Laparoscopic non-anatomical hepatectomy has the advantages of quick recovery, little complications and short hospitalization time in the treatment of patients with primary liver cancer.It can maintain the long-term curative effect similar to that of open hepatectomy, which fully reflects the advantages of laparoscopic minimally invasive surgery.
引文
[1] 王亮,折占飞,张俊斌,等.腹腔镜手术治疗肝良性肿瘤18例体位[J].腹腔镜外科杂志,2015,20(11):852-854.DOI:10.13499/j.cnki.fqjwkzz.2015.11.852.
[2] Reich H, McGlynn F, DeCaprio J,et al.Laparoscopic excision of benign liver lesions[J].Obstet Gynecol,1991,78(5Pt2):956-958.
[3] 周伟平,孙志宏,吴孟超,等.经腹腔镜肝叶切除首例报道[J].肝胆外科杂志,1994,2(2):82.
[4] Limongelli P, Vitiello C, Belli A, et al.Costs of laparoscopic and open liver and pancreatic resection:a systematic review[J].World J Gastroenterol,2014,20(46):17595-17602.DOI:10.3748/wjg.v20.i46.17595.
[5] 陈求赞.腹腔镜和开腹肝左外叶切除术62例对比分析[J/CD].中华普外科手术学杂志(电子版), 2016,10(2):174-176.DOI:10.3877/cma.j.issn.1674- 3946.2016.02.060.
[6] Wakabayashi G,Cherqui D,Geller DA,et al.Recommendations for laparoscopic liver resection:a report from the second international consensus conference held in Morioka[J].Ann Surg,2015,261(4):619-629.DOI:10.1097/SLA.0000000000001184.
[7] 王晓颖,高强,端猛,等.机器人辅助腹腔镜肝切除术142例报告[J].中国实用外科杂志,2017,37(5):548-551.DOI:10.19538/j.cjps.issn1005-2208.2017.05.21.
[8] Tranchaet H, Dagher I.Laparoscopic liver resection:a review[J].J Visc Surg,2014,151(2):107-115.
[9] 中华医学会外科学分会肝脏外科学组.腹腔镜肝切除术专家共识和手术操作指南(2013版)[J].中华外科学杂志,2013,51(4):289-292.DOI:10.3760/cma.j.issn.1673-9752.2013.03.001.
[10] 何沙,冯锦荣,卢永刚.腹腔镜与开腹肝切除术治疗边缘性肝肿瘤近期疗效分析[J].海南医学院学报,2017,23(7):914-917.DOI:10.13210/j.cnki.jhmu.20170323.001.
[11] 张建军,武金才.完全腹腔镜与开腹肝切除治疗肝肿瘤临床疗效比较[J].海南医学,2015,26(9):1349-1351.DOI:10.3969/j.issn.1003-6350.2015.09.0483.
[12] 靳斌,周兵海,杜刚,等.腹腔镜肝切除200例单中心经验[J].中华肝胆外科杂志,2016,22(9):587-590.DOI:10.3760/cma.j.issn.1007-8118.2016.09.002.
[13] Yin Z,Fan X,Ye H,et al.Short-and long-term outcomes after laparoscopic and open hepatectomy for hepatocellular carcinoma:a global systematic review and meta-analysis[J].Ann Surg Oncol, 2013, 20( 4):1203-1215.
[14] 王海涛,马魏杰,喻满成,等.腹腔镜肝切除术在治疗肝肿瘤中的临床应用价值[J].中华肝脏外科手术学电子杂志,2016,5(1):21-25.DOI:10.3877/cma.j.issn.2095-3232.2016.01.006.
[15] 佟庆,丁伟,晏冬,等.腹腔镜与开腹肝切除术治疗肝癌疗效的Meta分析[J].中国普通外科杂志,2015,24(1):27-28.DOI:10.3978/j.issn.1005-6947.2015.01.006.
[16] Nguyen KT, Marsh JW, Tsung A, et al.Comparative benefits of laparoscopic vs open hepatic resection:a critical appraisal[J].Arch Surg, 2011,146(3):348-356.
[17] 武金才,李灼日,周开论,等.完全腹腔镜肝切除术在肝肿瘤治疗中的应用和评价[J].肝胆胰外科杂志,2014,26(3):192-194.DOI:10.13709/j.cnki.1007-1954.2014.03.005.
[2] Reich H, McGlynn F, DeCaprio J,et al.Laparoscopic excision of benign liver lesions[J].Obstet Gynecol,1991,78(5Pt2):956-958.
[3] 周伟平,孙志宏,吴孟超,等.经腹腔镜肝叶切除首例报道[J].肝胆外科杂志,1994,2(2):82.
[4] Limongelli P, Vitiello C, Belli A, et al.Costs of laparoscopic and open liver and pancreatic resection:a systematic review[J].World J Gastroenterol,2014,20(46):17595-17602.DOI:10.3748/wjg.v20.i46.17595.
[5] 陈求赞.腹腔镜和开腹肝左外叶切除术62例对比分析[J/CD].中华普外科手术学杂志(电子版), 2016,10(2):174-176.DOI:10.3877/cma.j.issn.1674- 3946.2016.02.060.
[6] Wakabayashi G,Cherqui D,Geller DA,et al.Recommendations for laparoscopic liver resection:a report from the second international consensus conference held in Morioka[J].Ann Surg,2015,261(4):619-629.DOI:10.1097/SLA.0000000000001184.
[7] 王晓颖,高强,端猛,等.机器人辅助腹腔镜肝切除术142例报告[J].中国实用外科杂志,2017,37(5):548-551.DOI:10.19538/j.cjps.issn1005-2208.2017.05.21.
[8] Tranchaet H, Dagher I.Laparoscopic liver resection:a review[J].J Visc Surg,2014,151(2):107-115.
[9] 中华医学会外科学分会肝脏外科学组.腹腔镜肝切除术专家共识和手术操作指南(2013版)[J].中华外科学杂志,2013,51(4):289-292.DOI:10.3760/cma.j.issn.1673-9752.2013.03.001.
[10] 何沙,冯锦荣,卢永刚.腹腔镜与开腹肝切除术治疗边缘性肝肿瘤近期疗效分析[J].海南医学院学报,2017,23(7):914-917.DOI:10.13210/j.cnki.jhmu.20170323.001.
[11] 张建军,武金才.完全腹腔镜与开腹肝切除治疗肝肿瘤临床疗效比较[J].海南医学,2015,26(9):1349-1351.DOI:10.3969/j.issn.1003-6350.2015.09.0483.
[12] 靳斌,周兵海,杜刚,等.腹腔镜肝切除200例单中心经验[J].中华肝胆外科杂志,2016,22(9):587-590.DOI:10.3760/cma.j.issn.1007-8118.2016.09.002.
[13] Yin Z,Fan X,Ye H,et al.Short-and long-term outcomes after laparoscopic and open hepatectomy for hepatocellular carcinoma:a global systematic review and meta-analysis[J].Ann Surg Oncol, 2013, 20( 4):1203-1215.
[14] 王海涛,马魏杰,喻满成,等.腹腔镜肝切除术在治疗肝肿瘤中的临床应用价值[J].中华肝脏外科手术学电子杂志,2016,5(1):21-25.DOI:10.3877/cma.j.issn.2095-3232.2016.01.006.
[15] 佟庆,丁伟,晏冬,等.腹腔镜与开腹肝切除术治疗肝癌疗效的Meta分析[J].中国普通外科杂志,2015,24(1):27-28.DOI:10.3978/j.issn.1005-6947.2015.01.006.
[16] Nguyen KT, Marsh JW, Tsung A, et al.Comparative benefits of laparoscopic vs open hepatic resection:a critical appraisal[J].Arch Surg, 2011,146(3):348-356.
[17] 武金才,李灼日,周开论,等.完全腹腔镜肝切除术在肝肿瘤治疗中的应用和评价[J].肝胆胰外科杂志,2014,26(3):192-194.DOI:10.13709/j.cnki.1007-1954.2014.03.005.
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