切换至 "中华医学电子期刊资源库"
高级检索
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:
全文 ( ) 下载PDF ( ) 导出引用
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]. 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]. 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
[1]
Sotiropoulos GC, Machairas N, Kostakis ID, et al. Early experience in starting a laparoscopic liver resection program in Greece[J]. JSLS, 2017, 21(1):e2016.00110.
[2]
王雪飞, 胡明根, 赵国栋, 等. 三步法断肝在完全腹腔镜左半肝切除中的应用研究[J/CD]. 中华腔镜外科杂志（电子版）, 2015, 8(3):1-5.
[3]
Dokmak S, Raut V, Aussilhou B, et al. Laparoscopic left lateral resection is the gold standard for benign liver lesions: a case-control study[J]. HPB, 2014, 16(2):183-187.
[4]
Wang X, Li J, Wang H, et al. Validation of the laparoscopically stapled approach as a standard technique for left lateral segment liver resection[J]. World J Surg, 2013, 37(4):806-811.
[5]
Kanazawa A, Tsukamoto T, Shimizu S, et al. Laparoscopic hepatectomy for liver cancer[J]. Dig Dis, 2015, 33(5):691-698.
[6]
马渝城, 严律南. 微创理念下腹腔镜肝切除的现状分析[J/CD]. 中华肝脏外科手术学电子杂志, 2013, 2(6):358-362.
[7]
王雪飞, 胡明根, 赵国栋, 等. 一种腹腔镜标准术式的探索：模式化腹腔镜左半肝切除术[J/CD]. 中华腔镜外科杂志（电子版）, 2014, 7(3):160-166.
[8]
Belli G, Gayet B, Han HS, et al. Laparoscopic left hemihepatectomy a consideration for acceptance as standard of care[J]. Surg Endosc, 2013, 27(8):2721-2726.
[9]
Valente R, Sutcliffe R, Levesque E, et al. Fully laparoscopic left hepatectomy-a technical reference proposed for standard practice compared to the open approach: a retrospective propensity score model[J]. HPB, 2018, 20(4):347-355.
[10]
Ciria R, Cherqui D, Geller DA, et al. Comparative short-term benefits of laparoscopic liver resection: 9 000 cases and climbing[J]. Ann Surg, 2016, 263(4):761-777.
[11]
Cheung TT, Poon RT, Yuen WK, et al. Long-term survival analysis of pure laparoscopic versus open hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a single-center experience[J]. Ann Surg, 2013, 257(3):506-511.
[12]
Namgoong JM, Kim KH, Park GC, et al. Comparison of laparoscopic versus open left hemihepatectomy for left-sided hepatolithiasis[J]. Int J Med Sci, 2014, 11(2):127-133.
[13]
Ziogas IA, Tsoulfas G. Advances and challenges in laparoscopic surgery in the management of hepatocellular carcinoma[J]. World J Gastrointest Surg, 2017, 9(12):233-245.
[14]
Lee KF, Chong CN, Wong J, et al. Long-term results of laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma: a case-matched analysis[J]. World J Surg, 2011, 35(10):2268-2274.
[15]
van der Poel MJ, Besselink MG, Cipriani F, et al. Outcome and learning curve in 159 consecutive patients undergoing total laparoscopic hemihepatectomy[J]. JAMA Surg, 2016, 151(10):923-928.
[16]
李梅生, 李清汉, 甄作均, 等. Endo-GIA两步法在腹腔镜左半肝切除术中的应用价值[J/CD]. 中华肝脏外科手术学电子杂志, 2017, 6(5):363-366.
[17]
Xu HW, Liu F, Li HY, et al. Outcomes following laparoscopic versus open major hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a propensity score-matched analysis[J]. Surg Endosc, 2018, 32(2):712-719.
[18]
Yan CY, Cai XJ, Wang YF. Effect of selective inflow occlusion on hemodynamic conditions during laparoscopic left hemihepatectomy effect of selective inflow occlusion on hemodynamic conditions during laparoscopic left hemihepatectomy[J]. Hepatogastroenterology, 2012, 59(114):501-504.
[19]
Li M, Zhang T, Wang L, et al. Selective hemihepatic vascular occlusion versus pringle maneuver in hepatectomy for primary liver cancer[J]. Med Sci Monit, 2017(23):2203-2210.
[20]
Machado MA, Makdissi FF, Herman P, et al. Intrahepatic Glissonian approach for pure laparoscopic left hemihepatectomy[J].J Laparoendosc Adv Surg Tech A, 2010, 20(2):141-142.
[21]
陈焕伟, 邓斐文. 肝内Glissonian鞘外离断法行腹腔镜左半肝切除术[J/CD]. 中华腔镜外科杂志（电子版）, 2016, 9(4):236-238.
[22]
陈焕伟. 左肝蒂横断式腹腔镜左半肝切除术的新方法介绍[J]. 国际外科学杂志, 2018, 45(2):128-129,封4.
[23]
Chen HW, Deng FW, Hu JY, et al. Extra-glissonian approach for total laparoscopic left hepatectomy: a prospective cohort study[J]. Surg Laparosc Endosc Percutan Tech, 2017, 27(6):e145-148.
[1] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[2] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[3] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[4] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[5] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[6] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[7] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[8] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[9] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[10] 易明超, 汪鑫, 向涵, 苏怀东, 张伟. 一种T型记忆金属线在经脐单孔腹腔镜胆囊切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 599-599.
[11] 马涛, 叶春伟, 刘滔, 彭文希, 李志鹏. 腹腔镜与开放性离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻的比较[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 605-610.
[12] 刘成, 赖聪, 黄健, 王建辰, 罗茜芸, 许可慰. EDGE SP1000单孔手术机器人辅助腹腔镜下猪输尿管部分切除联合端端吻合术的可行性研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 642-646.
[13] 杜锡林, 谭凯, 贺小军, 白亮亮, 赵瑶瑶. 肝细胞癌转化治疗方式[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 597-601.
[14] 张继新, 胡军红, 谢爽, 武祖印, 张春旭. 经阴道单孔腹腔镜阑尾切除术可行性及近期疗效分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 460-465.
[15] 孙秀艳, 徐庆蕾, 马鹏涛, 胡志元, 郭传真, 祝成红. 腹腔镜胃癌根治术中患者体温变化与压力性损伤及受压部位微环境的相关性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 480-484.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号