摘要
目的探讨腹腔镜肝切除术与开腹肝切除术治疗原发性大肝癌近期疗效及远期预后的临床价值。方法选取2008年1月至2013年12月我院收治的118例原发性大肝癌患者作为研究对象,采用回顾性分析法分析所有患者的临床及随访资料,根据资料结果中不同手术方法将其分为对照组58例和观察组60例,对照组患者在原发性大肝癌常规基础治疗上予以开腹肝切除治疗,观察组在原发性大肝癌常规基础治疗上予以腹腔镜镜下肝切除治疗,根据其资料结果记录并比较两组患者的性别、年龄、疾病情况、术后并发症等一般临床资料,以及近期疗效和远期预后生存情况。结果 (1)两组患者在手术时间、术中出血量、输血率的比较上无差异(P>0.05),但观察组患者术后在重症监护室所待时间、术后开始下床活动时间、术后恢复肛门排气时间、术后拔除腹腔引流管时间以及术后住院时间均较对照组短,差异有统计学意义(P<0.05);(2)观察组患者术后并发症发生率(16.67%)显著低于对照组(34.48%),差异有统计学意义(P<0.05);(3)观察组患者3年总生存率和无复发生存率分别为80.00%和66.67%,对照组分别为79.31%和65.52%,差异无统计学意义(P>0.05)。结论腹腔镜肝切除手术治疗大肝癌患者具有更好的近期临床疗效和安全性,且远期预后生存效果类似于开腹手术肝切除治疗者,故可作为临床上治疗大肝癌患者的首选治疗方案。
Objective To investigate the short-term efficacy and long-term prognosis between laparoscopic hepatectomy and open hepatectomy for patients of primary large hepatocellular carcinoma. Methods One hundred and eighteen cases of primary liver cancer patients treated in our hospital between January 2008 and December 2013 were selected as subjects. The clinical and follow-up data of all the patients was analyzed retrospectively. According to surgical methods,these patients were divided into control group（ 58 cases） and observation group（ 60 cases）. The treatment group underwent laparotomy,while the observation group was treated with laparoscopic hepatectomy plus routine treatment of primary liver cancer. The general clinical data of the patients in the two groups was recorded and compared,such as sex,age,disease,postoperative complications,and short-term and long-term prognosis. Results（ 1） There was no difference between the two groups in the duration of surgery,amount of bleeding and or rate of blood transfusion（ P〉0.05）,but the patients in observation group spent less time in the intensive care unit,started their first ambulation after operation earlier,took less time to recover bowel movement,had the abdominal drainage tube removed earlier,and had a shorter hospital stay than the control group. The difference was statistically significant（ P〈0.05）.（ 2） The incidence of postoperative complications（ 16. 67%） in the observation group was significantly decreased compared with control group（ 34.48%）,and the difference was statistically significant（ P〈0.05）.（ 3） The total three-year survival rate and non-recurrent survival rate were 80% and 66.67% in the observation group,and 79.31% and 65.52% in the control group,respectively.The difference was not statistically significant（ P〉0.05）. Conclusion Laparoscopic hepatectomy has better short-term clinical efficacy and safety in the treatment of large liver cancer,and the long-term survival is similar to that of open hepatectomy,so it can be used as the first option for clinical treatment of large liver cancer patients.
作者
宋祥勇
张军
张永川
SONG Xiangyong;ZHANG Jun;ZHANG Yongchuan(Department of General Surgery,Dazhou Central Hospital,Dazhou,Sichuan,635000,Chin)
出处
《解放军预防医学杂志》
CAS
2018年第4期451-454,共4页
Journal of Preventive Medicine of Chinese People's Liberation Army
基金
四川省卫生厅基金资助项目(No.130476)
关键词
原发性大肝癌
腹腔镜
开腹
肝切除术
primary large hepatocellular carcinoma
laparoscopy
laparotomy
hepatectomy
作者简介
宋祥勇（1965-），男，大学本科，主治医师。从事普通外科临床工作。
