腹腔镜与开腹肝脏切除术治疗肝细胞癌的临床疗效分析

  目的  探讨腹腔镜与开腹肝脏切除术治疗肝细胞癌（hepatocellular carcinoma，HCC）的近期及远期临床疗效。  方法  回顾性分析2013年1月至2016年5月在福建医科大学附属第一医院行肝细胞癌切除患者的临床资料，为减少选择偏倚采用逐一配对法进行配对，最终纳入腹腔镜组105例，开腹组105例。比较手术及术后的无瘤生存率以及总生存率，并行统计学分析。  结果  腹腔镜组术后住院时间更短[（8.68±2.82）d vs.（10.61±2.95）d，P < 0.01]，肝门阻断率更低（20.0% vs. 41.0%，P < 0.01），且腹腔引流管拔除时间更早[（4.45±2.53）d vs.（5.40±2.43）d，P < 0.01]。腹腔镜组1、2、3年生存率分别为96.88%、87.54%、79.50%，开腹组1、2、3年生存率分别为94.91%、86.29%、76.37%（P=0.670）。腹腔镜组1、2、3年无瘤生存率分别为72.09%、60.16%、52.08%，开腹组1、2、3年无瘤生存率分别为69.48%、56.50%、48.13%（P=0.388）。  结论  腹腔镜肝脏切除术（laparoscopic liver resection，LLR）治疗肝细胞癌安全可行，与开腹肝脏切除术（open liver resection，OLR）相比，具有相当的远期疗效，同时腔镜组术后住院时间更短、肝门阻断率更低，且引流管拔除时间更早，显示较好的近期疗效。 

Clinical efficacy of laparoscopic liver resection versus open liver resection for hepato-cellular carcinoma

Objective:To compare the short-and long-term outcomes of laparoscopic liver resection (LLR) with those of open liver re-section (OLR) for hepatocellular carcinoma (HCC). Methods:Clinical data from patients who suffered from HCC and received LLR or OLR from January 2013 to May 2016 in The First Affiliated Hospital of Fujian Medical University were analyzed restrospectively. To over-come selection bias, a 1:1 match was performed via a case-control study. After case-control matching was completed, 105 patients were included in each group. Short-term outcomes of operation and postoperation as well as long-term outcomes, including disease-free survival and overall survival rates, were evaluated. Relevant statistical methods were used for statistical analysis. Results: The postoperative hospital stay of the laparoscopic group was shorter (8.68 ± 2.82 vs. 10.61 ± 2.95 days, P<0.01) and its use of portal triad clamping was less (20.0%vs. 41.0%, P<0.01) than those of the open group. The abdominal drainage tube of the laparoscopic group was also removed at an earlier time than that of the open group (4.45±2.53 vs. 5.40±2.43 days, P<0.01). The 1-, 2-, and 3-year overall survival rates of the laparoscopic group were 96.88%, 87.54%, and 79.50%, respectively. By comparison, the 1-, 2-, and 3-year overall survival rates of the open group were 94.91%, 86.29%, and 76.37%, respectively (P=0.670). The 1-, 2-, and 3-year disease-free survival rates of the laparoscopic group were 72.09%, 60.16%, and 52.08%, respectively, while the 1-, 2-, and 3-year disease-free survival rates of the open group were 69.48%, 56.50%, 48.13%, respectively (P=0.388). Conclusion:LLR is a safe and feasible procedure. LLR in the selected patients with HCC showed similar long-term outcomes to those of OLR. The postoperative hospital stay of these patients who underwent LLR was shorter and their use of portal triad clamping was less than those of the patients who received OLR. The abdomi-nal drainage tube of the former was also removed at an earlier time than that of the latter. Therefore, the short-term outcomes of LLR were better than those of OLR.