腹腔镜手术治疗高龄肝细胞癌患者的临床疗效分析

目的:比较腹腔镜肝切除术(LLR)与开放肝切除术(OLR)治疗高龄肝细胞癌患者的近期疗效与远期生存率。方法:回顾分析2014年1月至2017年12月手术治疗的52例高龄患者的临床资料,依据手术方式分为两组,OLR组(n=26)行开腹手术,LLR组(n=26)行腹腔镜手术。比较两组手术时间、术中出血量、术后肝功能指标、术后恢复情况及远期生存率。结果:LLR组手术时间长于OLR组,术中出血量、术后引流管留置时间、住院时间、术后并发症发生率优于OLR组,差异有统计学意义。术后第5天,LLR组ALT、TBIL水平低于OLR组,ALB水平高于OLR组,差异有统计学意义。两组术后1年、3年总生存率、无瘤生存率差异无统计学意义。结论:腹腔镜手术治疗高龄肝细胞癌患者疗效可靠,术中出血少,术后并发症发生率低,术后恢复快的同时降低了对肝功能的影响。     

腹腔镜肝切除术治疗复发性肝癌的围手术期和近期疗效观察

目的 本研究基于倾向评分匹配（PSM）对比腹腔镜肝切除术（LLR）和开腹肝切除术（OLR）治疗复发性肝细胞癌（rHCC）的围手术期和近期疗效,探讨其治疗安全性、有效性和临床应用价值。方法 回顾性分析2017年1月至2021年12月在温州市人民医院接受手术治疗的49例rHCC患者,按照手术方式分为LLR组（27例）和OLR组（22例）,通过倾向性评分匹配（PSM）筛选出34例用于数据分析,比较两组的临床基本资料、围手术期结果和术后复发情况。结果 PSM前,OLR组肿瘤大小、术中出血量和输血量、术后并发症发生率、住院时间均明显高于LLR组（P<0.05）。PSM后,两组在肿瘤大小、术中输血量和术后并发症发生率方面均无统计学差异,但LLR组术中出血量和术后住院时间明显少于OLR组（P<0.05）。两组无复发生存期（RFS）差异无统计学意义（P=0.383）。结论 LLR治疗rHCC可减少术中出血量和输血量,减少并发症发生率,缩短住院时间,围手术期和近期疗效优于OLR。在严格掌握手术适应证的前提下,LLR具有良好的安全可行性。     

腹腔镜与开腹肝切除术治疗肝癌疗效的Meta分析

目的：系统评价腹腔镜肝切除术（LLR）与开腹肝切除术（OLR）治疗肝癌的近、远期疗效和安全性。方法：检索相关期刊、资料、会议文献和学位论文数据库,收集比较LLR与OLR治疗肝癌疗效的病例-对照研究。按MOOSE 规范对纳入研究进行分析,提取数据并用RevMan5.3软件对数据进行Meta分析。
　　结果：最终共纳入15篇病例-对照研究,共1246例患者,LLR组499例,OLR组747例。Meta分析结果显示,LLR组与OLR组的手术时间,1、3、5年生存率,1、3、5年无瘤生存率,3年肿瘤复发率组间差异均无统计学意义（均P>0.05）;LLR与OLR相比术中出血量少、术后并发症发生率低、围手术期死亡率低、术后住院天数少（均P<0.05）。
　　结论：LLR可以达到与OLR同样的根治效果,两者近、远期疗效无明显差异,且LLR围手术期不良事件少于OLR。     

困难部位肿瘤的腹腔镜肝脏切除术

正自二十多年前Riech开展世界首例腹腔镜肝脏切除术(laparoscopic liver resection,LLR)以来,LLR的可行性和安全性现已得到确认。众多研究表明,与开腹肝切除相比较,LLR具有术中出血少、术后疼痛轻、并发症发生率低、恢复快、住院时间短,并具有明显的美容效果等诸多优势;肝恶性肿瘤患者LLR术后肿瘤复发率及生存率与开腹手术均无统计学差异[1-4]。随着腹腔镜手术器械的不断更新和手术经     

腹腔镜和开腹肝肿瘤切除的病例配对研究和费用效益对比研究

目的探讨腹腔镜肝肿瘤切除治疗肝脏肿瘤的临床疗效和费用效益。方法总结分析2013年1月到2013年12月在上海仁济医院肝脏外科行腹腔镜肝肿瘤切除(Laparoscopic Liver Resection,LLR)的39例患者的临床资料,根据患者年龄、手术方式和肿瘤大小为配对条件,在开腹肝肿瘤切除(Open Liver Resection,OLR)病例库中进行1:1配对抽选,共39例纳入LLR配对组。对行LLR病人和OLR病人进行病例配对研究和费用效益对比研究。结果两组患者在性别、年龄、手术方式、术前Child评分以及病种上的差别无统计学意义(P0.05),在肿瘤个数和大小方面两组患者也无显著的差异(P0.05)。LLR组手术时间和术中出血量分别为123.8±54.9min,171.8±218.5ml,均明显少于OLR组的182.1±50.9min,308.9±208.9ml(P0.05)。LLR组患者术后平均住院日、术后平均进食时间明显少于OLR组,且与OLR组相比,LLR组患者肝功能损伤较小,恢复的更快,差异有统计学意义(P0.05)。在住院费用中,LLR组患者的手术费用和总住院费用与OLR组相差无统计学意义。结论我们的研究不仅证实了腹腔镜肝肿瘤切除术治疗肝肿瘤是安全可行,具有一定的近期优势,而且具有较好的费用效益。     

腹腔镜与开腹肝切除术治疗术后复发性肝癌疗效比较的Meta分析

目的:比较腹腔镜肝切除术(LLR)与开腹肝切除术(OLR)治疗复发性肝癌的安全性与疗效.方法:检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、万方、维普与中国知网,搜索比较LLR与OLR治疗复发性肝癌疗效的队列研究,检索时限从建库至2021年3月3...     

腹腔镜肝切除术治疗合并血小板减少肝细胞癌患者的疗效和安全性

目的探讨腹腔镜肝切除(laparoscopic liver resection,LLR)对合并血小板减少肝细胞癌患者的有效性及安全性。 方法回顾性分析2020年4月至2022年11月首都医科大学附属北京佑安医院因肝细胞癌行LLR的141例患者临床资料,根据血小板计数(PLT)是否<100×10⁹/L分为PLT减少组和PLT正常组,比较两组患者术中出血量、肝门阻断比例、肝门阻断时间、手术时间、术中输血量、术中是否放置引流管、术后并发症、住院时间等数据,探讨PLT水平对LLR出血量的影响和手术的安全性。 结果141例患者完成LLR,术中均未输注红细胞悬液,PLT减少组和PLT正常组的中位出血量分别为100 mL和50 mL,两组间差异无统计学意义(P＝0.111),两组间肝门阻断比例、肝门阻断时间、手术时间和术中输血浆量均差异无统计学意义,PLT减少组放置引流管的比例明显高于PLT正常组(94.29%比78.50%,P＝0.040);PLT减少组与PLT正常组术后并发症发生率差异无统计学意义(20.00%比10.28%,P＝0.149);两组术后中位住院时间分别为7 d和6 d,差异无统计学意义(P＝0.062)。 结论通过仔细解剖、适当地肝门阻断和低中心静脉压技术,对合并血小板减少的肝细胞癌患者实施LLR是安全、可行的,经验丰富的腹腔镜肝脏外科医师还可以做到无输血LLR。     

腹腔镜肝切除术前难度评分的研究进展

随着腹腔镜设备的蓬勃发展和微创技术的日益精进,腹腔镜肝切除术(laparoscopic liver resection,LLR)已经成为治疗各种肝脏疾病的最重要手段之一.LLR在世界各地的普及程度越来越高,LLR的适应证也在不断扩大,但由于术中止血、肝实质离断等关键技术尚未完全攻克,LLR仍处在不断探索阶段.因此术前评...     

腹腔镜左半肝切除的解剖学观察及技术要点探讨

目的总结腹腔镜规则性左半肝切除的临床经验,探讨术中解剖学观察及技术要点。方法回顾分析2009年12月～2011年12月间的28例腹腔镜左半肝切除术的临床资料、手术录像及术中解剖学观察。结果全部患者手术均顺利完成,手术时间(205.0±39.3)min,术中出血量(182.5±57.8)ml,无严重并发症,住院时间(7.3±1.3)d。结论对于经过选择的患者,腹腔镜左半肝切除术可行、安全、微创。     

常规腹腔镜及腹腔镜超声下左半肝切除术治疗 原发性肝癌的临床疗效比较

目的:对比分析常规腹腔镜与腹腔镜超声(LUS)下左半肝切除术围手术期相关指标、并发症情况及预后,为临床术式选择提供可借鉴依据。方法:选择2013年3月至2016年3月140例行左半肝切除术的原发性肝癌患者作为研究对象,按手术方法将患者分为观察组与对照组,每组70例。观察组在LUS下行左半肝切除术,对照组行常规腹腔镜左半肝切除术。对比两组围手术期指标、术后并发症及术后3年生存情况。结果:观察组术中出血量[(311.21±59.43)mL vs.(415.81±88.42)mL,t=8.215,P0.001]少于对照组,术中肝中静脉损伤发生率(0 vs.14.29%,χ~2=8.723,P=0.003)低于对照组。两组手术时间、病灶切缘距离、术后肛门首次排气时间、引流管拔管时间及术后并发症发生率差异均无统计学意义(P0.05)。两组术后3年无进展生存率(45.71%vs.38.57%,χ~2=0.732,P=0.392)、总生存率(64.29%vs.58.57%,χ~2=0.482,P=0.487)差异均无统计学意义。结论:LUS与常规腹腔镜左半肝切除术治疗原发性肝癌的术后并发症、预后相近,但LUS有助于减少术中肝中静脉损伤及术中出血量。     

Laparoscopic vs open hepatic resection: a comparative study

Background: Although the feasibility of minor laparoscopic liver resections (LLR) has been demonstrated, data comparing the open vs the laparoscopic approach to liver resection are lacking. Methods: We compared 30 LLR with 30 open liver resections (OLR) in a pair-matched analysis. The indications for resection were malignant disease in 47% of the LLR and 83% of the OLR. The average size of the lesions was 42 mm for LLR and 41 mm for OLR. Five wedge resections, 12 segmentectomies, and 13 bisegmentectomies were performed in each group. Results: The conversion rate for LLR was nil. The mean operative time was 148 min for LLR and 142 min for OLR. Mean blood loss was minimal in the LLR group (320 vs 479 ml; p < 0.05). Postoperative complications occurred in 6.6% of the patients in each group; there were no deaths. The mean postoperative hospital stay was shorter for LLR patients (6.4 vs 8.7 days; p < 0.05). In tumors, the resection margin was <1 cm in 43% of the LLR patients and 40% of the OLR patients (p = NS). Conclusions: Minor LLR of the anterior segments has the same rates of mortality and morbidity as OLR. However, the laparoscopic approach reduces blood loss and postoperative hospital stay.     

Long-term survival outcome of laparoscopic liver resection for hepatocellular carcinoma

Long-term survival is the most important outcome measurement of a curative oncological treatment. For hepatocellular carcinoma (HCC), the long-term disease-free and overall survival of laparoscopic liver resection (LLR) is shown to be non-inferior to the current standard of open liver resection (OLR). Some studies have reported a superior long-term oncological outcome in LLR when compared to OLR. It has been argued that improvement of visualization and instrumentation and reduced operative blood loss and perioperative blood transfusion may contribute to reduced risk of postoperative tumor recurrence. On the other hand, since most of the comparative studies of the oncological outcomes of LLR and OLR for HCC are non-randomized, it remained inconclusive as to whether LLR confers additional survival benefit compared to OLR. Despite the paucity of level 1 evidence, the practice of LLR for HCC has gained wide-spread acceptance due to the reproducible improvements in the perioperative outcomes and non-inferior oncological outcomes demonstrated by large-scaled, matched comparative studies. Meta-analyses of the outcomes of these studies by multiple systematic reviews have also returned noncontradictory conclusions. On the basis of a theoretical advantage of LLR over OLR in preventing tumor recurrence, the current review aims to dissect from the current meta-analyses and comparative studies any evidence of such superiority.     

腹腔镜手术治疗肝内胆管细胞癌研究现状

肝内胆管细胞癌（ICC）是仅次于肝细胞癌的第二大原发性肝癌,发病率逐年上升,手术是唯一可能治愈ICC的方法。但由于ICC的生物学特性,腹腔镜肝切除术治疗ICC在操作规范和疗效上仍存在争议。对于ICC病人,腹腔镜肝切除术中实施淋巴结清扫安全可行,与开放手术相比,腹腔镜肝切除术具有术中出血量少、术后并发症发生率低、术后住院时间短等优势,并未增加病人围术期病死率,但在远期疗效上暂未体现优势。     

Perioperative analysis of laparoscopic versus open liver resection

Background   Over the past decade there has been an increasing trend toward minimally invasive liver surgery. Initially limited by technical challenges, advances in laparoscopic techniques have rendered this approach safe and feasible. However, as health care costs approach 50% of some provincial budgets, surgical innovation must be justifiable in costs and patient outcomes. With introduction of standardized postoperative liver resection guidelines to optimize patient hospital length of stay, the advantages of laparoscopic liver resection (LLR) compared with open liver resection (OLR) measured by perioperative outcomes and resource utilization are not well defined. It remains to be established whether LLR is superior to OLR by these measurements. Methods  Eighteen LLRs performed at the Vancouver General Hospital from 2005 to 2007 were prospectively analyzed. These data were compared with an equivalent group of 12 consecutive OLRs undertaken immediately prior to the introduction of LLR. Outcomes were evaluated for differences in perioperative morbidity, hospital length of stay, and operative costs. Results  There were no differences between LLRs and OLRs in demographics, pathology, cirrhosis, tumour location or extent of resection. There were no deaths. LLRs had significantly decreased intraoperative blood loss (287 ml versus 473 ml, p = 0.03), postoperative complications (6% versus 42%, p = 0.03), and length of stay (4.3 versus 5.8 days, p = 0.01) compared with OLRs. There were no differences in operating time for LLRs compared to OLRs (135 min versus 138 min, respectively), total time in the operating theatre (214 min versus 224 min), or costs related to stapler/trocar devices (CA $1267 versus CA $1007). Conclusions  LLR is associated with decreased morbidity and decreased resource utilization compared with OLR. Perioperative patient outcomes and cost-effectiveness justify LLR despite introduction of standardized postoperative liver resection guidelines and decreased length of stay for OLR.     

Laparoscopic liver resection facilitates salvage liver transplantation for hepatocellular carcinoma

Background/Purpose  In patients with hepatocellular carcinoma (HCC), a previous liver resection (LR) may compromise subsequent liver transplantation (LT) by creating adhesions and increasing surgical difficulty. Initial laparoscopic LR (LLR) may reduce such technical consequences, but its effect on subsequent LT has not been reported. We report the operative results of LT after laparoscopic or open liver resection (OLR). Methods  Twenty-four LT were performed, 12 following prior LLR and 12 following prior OLR. The LT was performed using preservation of the inferior vein cava. Indication for the LT was recurrent HCC in 19 cases (salvage LT), while five patients were listed for LT and underwent resection as a neoadjuvant procedure (bridge resection). Results  In the LLR group, absence of adhesions was associated with straightforward access to the liver in all cases. In the OLR group, 11 patients required long and hemorrhagic dissection. Median durations of the hepatectomy phase and whole LT were 2.5 and 6.2 h, and 4.5 and 8.3 h in the LLR and OLR groups, respectively (P < 0.05). Median blood loss was 1200 ml and 2300 ml in the LLR and OLR groups, respectively (P < 0.05). Median transfusions of hepatectomy phase and whole LT were 0 and 3 U, and 2 and 6 U, respectively (P < 0.05). There were no postoperative deaths. Conclusions  In our study, LLR facilitated the LT procedure as compared with OLR in terms of reduced operative time, blood loss and transfusion requirements. We conclude that LLR should be preferred over OLR when feasible in potential transplant candidates.     

Long-term surgical outcomes in patients with hepatocellular carcinoma undergoing laparoscopic vs. open liver resection: A retrospective and propensity score-matched study

Background/objectivesThere is limited availability of well-designed comparative studies using propensity score matching with a sufficient sample size to compare laparoscopic liver resection (LLR) vs. open liver resection (OLR) for hepatocellular carcinoma (HCC). We aimed to compare the feasibility and safety of LLR and OLR in patients with HCC.MethodsWe enrolled 168 patients who underwent elective LLR (n = 58) or OLR (n = 110) for HCC in two tertiary medical centers between November 2009 and December 2018. Patients who underwent LLR were propensity score-matched to patients who underwent OLR in a 1:1 ratio. Perioperative and postoperative outcomes and disease-free and overall survival rates were prospectively evaluated.ResultsAmong the 116 patients analyzed, 58 each belonged to the LLR and OLR groups. We performed 85 segmentectomies or sectionectomies, 19 left-lateral-sectionectomies, 9 left-hemihepatectomies, and 3 right-hemihepatectomies. There was no significant difference in age, sex, Child-Pugh class, original liver disease, preoperative alpha-fetoprotein, tumor size, tumor location, overall morbidity, and operative time. There was a significant difference in the length of postoperative hospital stay between the two groups (LLR vs OLR; 8 vs 10 days, p = 0.003). The 1-, 3-, and 5-year overall survival rates in the LLR and OLR groups were 96.6%, 92.8%, and 73.3% and 93.1%, 88.8%, and 76.1%, respectively (p = 0.642). The 1-, 3-, and 5-year disease-free survival rates in the LLR and OLR groups were 84.4%, 64.0%, and 60.2% and 93.1%, 67.4%, and 63.9%, respectively (p = 0.391).ConclusionLLR for HCC can be performed safely with acceptable short-term and long-term outcomes compared with OLR.     

Short-term and middle-term evaluation of laparoscopic hepatectomies compared with open hepatectomies: A propensity score matching analysis

AIM To compare short-term results between laparoscopic hepatectomy and open hepatectomy using a propensity score matching. METHODS A patient in the laparoscopic liver resection(LLR) groupwas randomly matched with another patient in the open liver resection(OLR) group using a 1:1 allocated ratio with the nearest estimated propensity score. Patients of the LLR group without matches were excluded. Matching criteria included age, gender, body mass index, American Society of Anesthesiologists score, potential co-morbidities, hepatopathies, size and number of nodules, preoperative chemotherapy, minor or major liver re-sections. Intraoperative and postoperative data were compared in both groups.RESULTS From January 2012 to January 2015, a total of 241 hepa-tectomies were consecutively performed, of which 169 in the OLR group(70.1%) and 72 in the LLR group(29.9%). The conversion rate was 9.7%(n = 7). The mortality rate was 4.2% in the OLR group and 0% in the LLR group. Prior to and after propensity score matching, there was a statistically significant difference favorable to the LLR group regarding shorter operative times(185 min vs 247.5 min; P = 0.002), less blood loss(100 m L vs 300 m L; P = 0.002), a shorter hospital stay(7 d vs 9 d; P = 0.004), and a significantly lower rate of medical complications(4.3% vs 26.4%; P 0.001). CONCLUSION Laparoscopic liver resections seem to yield better short-term and mid-term results as compared to open hepatectomies and could well be considered a privileged approach and become the gold standard in carefully selected patients.