摘要
目的探讨腹腔镜下肝静脉导向解剖性肝切除术治疗肝细胞癌的可能优势。方法回顾分析2015年1月至2018年2月陆军军医大学西南医院肝胆外科符合纳入标准的62例行腹腔镜解剖性肝切除术患者的临床资料。以肝静脉主干的显露与否区分手术方式,分为显露肝静脉主干的肝静脉导向肝切除(HVOH)组与未显露肝静脉主干的传统(TAH)组,对比分析两种手术方式的围手术期指标及随访结果。结果HVOH组纳入31例,其中男性28例,女性3例,年龄29.0~70.0(49.9±11.2)岁;TAH组纳入31例,其中男性27例,女性4例,年龄22.0~73.0(51.4±12.1)岁。两组患者手术时间、术中出血量、术后住院时间、术中中转开腹率、围手术期输血率差异无统计学意义(P>0.05)。术后并发症发生率HVOH组比TAH组低[9.7%(3/31)比32.2%(10/31)],差异具有统计学意义(P<0.05),但均未发生严重并发症(ClaveinⅣ级)。HVOH组1年无瘤生存率高于TAH组(77.4%比51.6%),差异有统计学意义(P<0.05)。两组1年、3年总生存率及无瘤生存率差异均无统计学意义(P>0.05)。结论腹腔镜下肝静脉导向解剖性肝切除术治疗肝细胞癌在降低患者围手术期并发症发生率上有潜在优势,可能提高早期无瘤生存率、改善肿瘤学结果。
Objective To study the use of laparoscopic hepatic vein guided anatomic hepatectomy in the treatment of hepatocellular carcinoma.Methods The clinical and follow-up data of 62 patients who underwent laparoscopic anatomic hepatectomy at the Department of Hepatobiliary Surgery of Southwest Hospital of the Army Medical University from January 2015 to February 2018 and met the inclusion criteria of the study were retrospectively analyzed. The operation procedure as to whether the main hepatic vein was exposed or not was determined. The patients were divided into the hepatic vein-oriented hepatectomy (HVOH) group when the main hepatic vein was exposed, and the traditional anatomic hepatectomy (TAH) group when the main hepatic vein was not shown. The perioperative and follow-up data of the two methods were compared.Results A total of 31 cases were included in the HVOH group, there were 28 males and 3 females, age ranged from 29.0-70.0 (49.9±11.2) years. A total of 31 cases were included in the TAH group, there were 27 males and 4 females, age ranged from 22.0-73.0 (51.4±12.1) years. There were no significant differences in operation time, intraoperative blood loss, postoperative hospital stay, intraoperative conversion to open, and perioperative blood transfusion rates between the two groups (P>0.05). The incidence of postoperative complication was significantly lower in the HVOH group than in the TAH group [9.7% (3/31) vs. 32.2% (10/31)] (P<0.05), but no serious complications occurred (Clavein Level IV) in this study. The one-year tumor-free survival rate in the HVOH group was significantly higher than that in the TAH group (77.4% vs. 51.6%), (P<0.05). There were no significant differences in the 1- and 3-year overall survival rates and tumor-free survival rates between the two groups (P>0.05).Conclusion Laparoscopic hepatic vein-guided anatomic hepatectomy for hepatocellular carcinoma had the potential advantages in reducing the perioperative complication rate, and enhanced the early tumor-free survival rates.
作者
廖科曦
曹利
黄登
孙天歌
李雪松
王小军
李建伟
陈健
郑树国
Liao Kexi;Cao Li;Huang Deng;Sun Tiange;Li Xuesong;Wang Xiaojun;Li Jianwei;Chen Jian;Zheng Shuguo(Department of Hepatobiliary Surgery,Southwest Hospital,Army Military Medical University,Chongqing 400038,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2020年第5期339-344,共6页
Chinese Journal of Hepatobiliary Surgery
基金
国家自然科学基金(81670597)
第三军医大学第一附属医院重大领域技术创新项目(SWH2016ZDCX2015)。
关键词
腹腔镜
解剖性肝切除术
癌
肝细胞
Laparoscopes
Anatomic hepatectomy
Carcinoma,hepatocellular
作者简介
通信作者:郑树国,Email:shuguozh@163.com。
