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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2018, Vol. 07 ›› Issue (06) : 477 -481. doi: 10.3877/cma.j.issn.2095-3232.2018.06.011

所属专题： 文献；

临床研究

腹腔镜与开腹左半肝切除治疗肝细胞癌临床对比研究
符荣党1, 李杰原2, 王峰杰2, 邓斐文2, 雷秋成2, 胡健垣2, 陈焕伟2,†()   
  1. 1. 528000　佛山市第一人民医院肝脏胰腺外科；510630　广州，中山大学附属第三医院感染科
    2. 528000　佛山市第一人民医院肝脏胰腺外科
  • 收稿日期:2018-09-06 出版日期:2018-12-10
  • 通信作者: 陈焕伟
  • 基金资助:
    2016年高校和医院科研基础平台项目(2016AG100561); 广东省医学科研基金项目(A2017387，A2018145)

Comparative study of laparoscopic and open left hepatectomy for hepatocellular carcinoma

Rongdang Fu1, Jieyuan Li2, Fengjie Wang2, Feiwen Deng2, Qiucheng Lei2, Jianyuan Hu2, Huanwei Chen2,†()   

  1. 1. Department of Hepatopancreatobiliary Surgery, the First People's Hospital of Foshan, Foshan 528000, China; Department of Infectious Disease, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    2. Department of Hepatopancreatobiliary Surgery, the First People's Hospital of Foshan, Foshan 528000, China
  • Received:2018-09-06 Published:2018-12-10
  • Corresponding author: Huanwei Chen
  • About author:
    Corresponding author: Chen Huanwei, Email:
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引用本文：

符荣党, 李杰原, 王峰杰, 邓斐文, 雷秋成, 胡健垣, 陈焕伟. 腹腔镜与开腹左半肝切除治疗肝细胞癌临床对比研究[J/OL]. 中华肝脏外科手术学电子杂志, 2018, 07(06): 477-481.

Rongdang Fu, Jieyuan Li, Fengjie Wang, Feiwen Deng, Qiucheng Lei, Jianyuan Hu, Huanwei Chen. Comparative study of laparoscopic and open left hepatectomy for hepatocellular carcinoma[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(06): 477-481.

目的

比较腹腔镜及开腹左半肝切除治疗肝细胞癌（肝癌）的安全性及疗效。

方法

回顾性分析2011年6月至2017年12月在佛山市第一人民医院行左半肝切除的31例肝癌患者临床资料。其中男24例，女7例；年龄11～78岁，中位年龄58岁。根据手术方式不同将患者分为腹腔镜左半肝切除组（腹腔镜组，17例）和开腹左半肝切除组（开腹组，14例）。患者均签署知情同意书，符合医学伦理学规定。腹腔镜组采用Endo-GIA两步法腹腔镜左半肝切除，开腹组采用常规手术。两组术后住院时间比较采用t检验，术中出血量比较采用秩和检验，术后并发症比较采用χ2检验。

结果

两组均顺利完成手术，无围手术期死亡。腹腔镜组术中出血量中位数为100（50～500）ml，明显少于开腹组的325（50～900）ml（Z=-2.180，P<0.05）。腹腔镜组术后住院时间（8.4±2.3）d，明显短于开腹组的（10.9±2.5）d（t=-2.869，P<0.05）。腹腔镜组术后胸腔积液5例，开腹组5例，两组比较差异无统计学意义（χ2=0.140，P>0.05）。

结论

腹腔镜左半肝切除治疗肝癌是安全的，疗效与开腹手术相当，但术中出血量明显减少，患者术后恢复更快，可作为标准术式在临床推广应用。

关键词: 癌，肝细胞, 肝切除术, 腹腔镜
Objective

To compare the safety and efficacy of laparoscopic and open left hepatectomy for hepatocellular carcinoma (HCC).

Methods

Clinical data of 31 patients with HCC who underwent left hepatectomy in the First People's Hospital of Foshan from June 2011 to December 2017 were retrospectively analyzed. Among 31 patients, 24 cases were male and 7 female, aged from 11 to 78 years with a median age of 58 years. Patients were divided into laparoscopic left hepatectomy group (laparoscopic group, n=17) and open left hepatectomy group (open group, n=14). The informed consents of all patients were obtained and the local ethical committee approval was received. In laparoscopic group, two-step Endo-GIA laparoscopic left hepatectomy was performed, and conventional hepatectomy was performed in open group. The postoperative length of hospital stay was compared by t test. The intraoperative blood loss was compared by rank-sum test. The incidence of postoperative complications was compared by Chi-square test.

Results

All patients underwent operation successfully without perioperative death. The median intraoperative blood loss in laparoscopic group was 100(50-500) ml, significantly less than 325(50-900) mlin open group (Z=-2.180, P<0.05). The postoperative length of hospital stay in laparoscopic group was (8.4±2.3) d, significantly shorter than (10.9±2.5) d in the open group (t=-2.869, P<0.05). 5 cases developed postoperative pleural effusion in laparoscopic group, and 5 in open group, where no significant difference was observed (χ2=0.140, P>0.05).

Conclusions

Laparoscopic left hepatectomy is safe for HCC and has similar efficacy as open surgery, the intraoperative blood loss is less comparatively and postoperative recovery time is shorter, which can serve as a standard surgical approach in clinical practice.

Key words: Carcinoma, hepatocellular, Hepatectomy, Laparoscopes
表1 腹腔镜组和开腹组肝癌左半肝切除术患者一般资料比较（例）
临床参数 组别 χ2值 P值
腹腔镜组 开腹组
年龄（岁） ? ? 0.550 0.815
? < 60 9 8 ? ?
? ≥60 8 6
性别 ? ? 1.005 0.316
? 男 12 12 ? ?
? 女 5 2
HBsAg ? ? 0.754 0.385
? 阴性 3 1 ? ?
? 阳性 14 13
AFP（μg/L） ? ? 0.682 0.409
? ≤20 11 7 ? ?
? > 20 6 7
肿瘤直径（cm） ? ? 2.425 0.119
? < 3 12 6 ? ?
? ≥3 5 8
病理分级 ? ? 0.406 0.524
? 中低分化 9 9 ? ?
? 高分化 8 5
肝硬化 ? ? 1.770 0.183
? 无 6 2 ? ?
? 有 11 12
微血管侵犯 ? ? 1.309 0.253
? 无 14 9 ? ?
? 有 3 5
表2 腹腔镜组和开腹组肝癌患者围手术期指标比较
组别 例数 手术时间（min，±s） 术中出血量[ml，M（QR）] 术后住院时间（d，±s）
腹腔镜组 17 283±60 100（50～500） 8.4±2.3
开腹组 14 283±83 325（50～900） 10.9±2.5
统计值 ? t=-0.190 Z=-2.180 t=-2.869
P值 ? 0.985 0.029 0.008
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