摘要
目的探讨腹腔镜肝切除术与开腹肝切除术治疗肝细胞癌的疗效。方法采用回顾性分析方法。收集2015年1月31日至2017年1月31日160例在解放军总医院第五医学中心肝胆外科行肝切除术的肝细胞癌患者的临床及病理资料,其中行腹腔镜肝切除术(A组)患者80例,行开腹肝切除术(B组)患者80例。观察指标:(1)手术时间、术中出血量、切口长度、术后首次下床时间、术后首次进食时间、住院时间;(2)术后第1天的肝功能、白细胞、降钙素原及术后并发症等情况;(3)两组患者术后生活质量量表(QLQC 30评分)情况;(4)随访患者术后生存时间,分析手术方式与患者长期生存及无复发生存率之间的关系。结果(1)术中情况:A组患者手术时间、术中出血量、切口长度及住院时间均少于B组患者(P<0.05),术后首次下床时间、术后首次进食时间均早于B组患者(P<0.05)。(2)术后情况:A组患者术后第1天的肝功能、血常规及降钙素原等明显好于B组患者(P<0.05),A组患者术后发生腹腔感染、胸水等并发症低于B组患者(P<0.05)。(3)两组患者术后3个月的QLQ-C 30较术前评分均升高,A组患者术后3个月的QLQ-C 30评分明显高于B组患者(P<0.05)。(4)A组患者术后3年生存率及术后1年无复发生存率均好于B组患者。结论腹腔镜肝切除术治疗肝细胞癌安全可行,并发症少,能提高患者生存质量,值得临床推广应用。
Objective To evaluate the efficacy of laparoscopic hepatectomy and open hepatectomy for hepatocellular carcinoma.Methods A retrospective analysis was conducted on clinical and pathological data of 160 patients with hepatocellular carcinoma who underwent liver resection at the Fifth Medical Center of PLA General Hospital from Jan.31,2015 to Jan.31,2017.There were 80 patients in the laparoscopic hepatectomy group(group A)and 80 patients in the open hepatectomy group(group B).Observation indicators were as follows:(1)operation time,intraoperative blood loss,incision length,the first time to get out of bed,the first feeding time,length of hospital stay;(2)liver function,white blood cells,procalcitonin on the first day after operation and postoperative complications;(3)postoperative quality of life questionnaire score 30(QLQ-C 30)of the two groups of patients;(4)follow-up of patients’postoperative survival time,and analysis of the relationship between different surgical methods and long-term or recurrence-free survival rate of patients.Results(1)Intraoperative conditions:the operation time,intraoperative blood loss,incision length,and length of hospital stay in group A were shorter than those in group B(P<0.05),and the first time to get out of bed after operation and the first feeding time after operation were shorter than those in group B(P<0.05).(2)Postoperative conditions:the parameters of liver function,routine blood test,and procalcitonin of patients in group A were significantly better than those of patients in group B(P<0.05).Compared with that in group B,incidence of complications such as abdominal infection and pleural effusion in group A was lower(P<0.05).(3)The QLQ-C 30 in both groups increased at 3 months after operation.The QLQ-C 30 scores in group A were significantly higher than that in group B(P<0.05).(4)The 3-year survival rate and 1-year recurrence-free survival rate of patients in group A were higher than those in group B.Conclusion Laparoscopic hepatectomy is safe and feasible in treatment of hepatocellular carcinoma,with fewer postoperative complications and better life quality,which is worthy of clinical application.
作者
雷光林
李媛媛
李智
洪智贤
LEI Guanglin;LI Yuan-yuan;LI Zhi;HONG Zhi-xian(Department of First Hepatobiliary Surgery Center,the Fifth Medical Center of PLA General Hospital,Beijing 100039,China;Department of Liver Cirrhosis Diagnosis and Treatement Center,the Fifth Medical Center of PLA General Hospital,Beijing 100039,China;Department of Hepatobiliary Surgery,the First Medical Center of PLA General Hospital,Beijing 100853,China)
出处
《肝胆胰外科杂志》
CAS
2020年第5期280-285,共6页
Journal of Hepatopancreatobiliary Surgery
关键词
腹腔镜肝切除术
开腹肝切除术
肝细胞癌
laparoscopic hepatectomy
open hepatectomy
hepatocellular carcinoma
