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。

Perioperative and short-term outcome of laparoscopic liver resection for recurrent HCC

Objective The study aimed to compare the perioperative and short-term outcomes between laparoscopic liver resection (LLR) and open liver resection (OLR) in recurrent hepatocellular carcinoma (rHCC) using propensity score matching (PSM), to investigate the therapeutic safety, efficacy and value of clinical application. Methods Forty-nine patients with rHCC who underwent limited liver resection at Wenzhou People’s Hospital between Jan. 2017 and Dec. 2021 were retrospectively analyzed and classified into LLR group (n=27) and OLR group (n=22). Thirty-four patients were selected after PSM and the basic clinical characteristics, perioperative outcomes, and postoperative recurrence between two groups were compared. Results Before PSM, patients in the OLR group had larger tumor diameter, more intraoperative blood loss and units of blood transfused, higher postoperative complication incidence, and longer time of hospitalization than those in the LLR group (P<0.05). After PSM, there was no significant difference in terms of tumor size, blood transfusion, or postoperative complication incidence between the LLR and OLR groups. Intraoperative blood loss and postoperative time of hospitalization in the LLR group were significantly lower than those in the OLR group (P<0.05). The difference of recurrent-free survival (RFS) between the two groups was not statistically significant (P=0.383). Conclusion LLR for rHCC can reduce intraoperative blood loss and postoperative complication incidence, shorten the time of hospitalization, which is superior to OLR in terms of perioperative and short-term efficacy. LLR has great safety and feasibility under the premise of strict indications for surgery.