腹腔镜肝切除治疗肝细胞癌的安全性和长期疗效观察

目的 探讨腹腔镜肝切除治疗肝细胞癌的安全性及长期疗效。方法 回顾性分析2014年1月至2019年12月间在佛山市第一人民医院诊治的197例肝细胞癌患者的手术时间、中转开腹率、术中出血、术中输血量及术后并发症等围术指标，术后平均住院时间、肿瘤复发率、无瘤生存率，术后1、3、5年总的生存期等数据。结果 术中出血量为263.59±252.9 mL，手术时间为320.5±119.56 min。无围手术期死亡病例，术后发生腹腔积液9例（4.6%），胸腔积液9例（4.6%），胆漏3例（1.5%），术后出血4例（2.0%），术后肺炎2例（1.0%），术后总并发症发生率为13.7%(27/197)。术后住院时间为8.9±3.63天。随访至2021年6月1日，共有67例患者肿瘤复发，无瘤中位生存时间为78个月，复发率34%。术后1、3、5年无瘤生存期分别为84.2%、65.2%、59.4%。术后1、3、5年总生存期分别为96.3%、86.8%、83.6%。结论 腹腔镜肝切除治疗肝细胞癌是安全可行的，长期疗效与开腹肝切除无明显差异。

Observation of the safety and long-term efficacy of laparoscopic liver resection for the treatment of hepatocellular carcinoma

Objective To Investigate the safety and long-term efficacy of laparoscopic liver resection for patients with hepatocellular carcinoma. Methods The clinical data of 197 hepatocellular carcinoma patients with treated in Foshan First People′s Hospital from January 2014 to December 2019 were retrospectively analyzed. The data were analyzed for their perioperative indexes such as operative time, intermediate open rate, intraoperative blood loss, intraoperative blood transfusion and postoperative complications, mean postoperative hospital stay, tumor recurrence rate, tumor-free survival rate, and overall survival at 1, 3 and 5 years after surgery. Results There were no deaths during the perioperative period. Intraoperative blood loss was 263. 59±; 252. 9 mL, the operation time was 320. 5±; 119. 56 min. There was no perioperative death, no postoperative liver failure, no postoperative wound infection; 9 cases of abdominal effusion, 9 cases of pleural effusion after operation. There were 3 cases of bile leakage, 4 cases of postoperative bleeding, and 2 cases of postoperative pneumonia. The total complication rate was 13. 7%. The postoperative hospital stay was 8.9±; 3.63 days. Followed up until June 1 2021, a total of 67 patients had tumor recurrence. The median tumor-free survival time was 78 months, and the recurrence rate was 34%. The tumor-free survival at 1, 3, and 5 years after surgery was 84. 2%, 65. 2%, and 59. 4%. The overall survival period of 1, 3, and 5 years after operation was 96. 3%, 86. 8%, and 83. 6%. Conclusion Laparoscopic hepatectomy for hepatocellular carcinoma is safe and feasible, its long-term outcomes do not differ significantly from those of open hepatectomy.