腹腔镜与开腹肝左叶部分切除治疗肝癌的临床疗效分析

【摘要】〓目的〓探讨腹腔镜肝左叶部分切除治疗肝癌的近期及远期临床疗效。方法〓回顾性分析2008年5月~2012年6月我科51例腹腔镜下肝左叶部分切除术(腹腔镜组)与50例开腹肝左叶部分切除术(开腹组)的临床资料,比较两组患者手术时间、术中出血量、住院时间、并发症、住院费用和生存率、复发率。结果〓腹腔镜组手术时间长于开腹组(128.6±29.7 min vs 106.3±26.5 min, P<0.05),术中出血量多于开腹组(180.5±53.6 mL vs 130.2±44.5 mL, P<0.05),住院时间短于开腹组(6.8±1.4 d vs 11.4±3.0 d,P<0.05),住院费用少于开腹组(3.1±0.5万元 vs 3.3±0.6万元, P<0.05),两组术后并发症发生率(3.9% vs 6.0%)无差异。腹腔镜组中位生存时间为40个月,1、2、3年生存率分别为90.2%、80.4%、68.6%;开腹组中位生存时间为41个月,1、2、 3年生存率分别为90.0%、82.0%、66.0%。腹腔镜组中位无瘤生存时间为29个月,l、2、3年复发率分别为19.6%、45.1%、54.9%;开腹组中位无瘤生存时间为31个月,1、2、3年复发率分别为22.0%、42.0%、50.0%。结论〓腹腔镜肝左叶部分切除安全可行,不影响肝癌患者的预后,与开腹手术相比,具有微创,术后恢复快,住院时间短,费用低的优势。

Comparative study of partial left liver resection between laparoscopic surgery and open surgery for treatment of hepatocellular carcinoma

Objective To evaluate the short- and long-term efficacy of laparoscopic partial left liver resection for treatment of hepatocellular carcinoma. Methods The clinical data of 51 patients who received laparoscopic partial left liver resection（laparoscopic group） were retrospectively compared with 50 patients who underwent open partial left liver resection （open group） from May 2008 to June 2012. The duration of operation, intraoperative blood loss, hospital stay, postoperative complications, hospital cost and the rate of survival and recurrence were compared respectively. Results The duration of operation was longer in laparoscopic group than that in open group（128.6±29.7 min vs 106.3±26.5 min, P〈0.05）, the blood loss during operation was more than that in open group （180.5±53.6 ml vs 130.2±44.5 ml, P〈0.05）. Average hospital stay in laparoscopic group was shorter than that in open group （6.8±1.4 d vs 11.4±3.0, P〈0.05）. Total hospital cost in laparoscopic group was lower than that in open group（P〈0.05）. The rate of postoperative complications between the two groups was not statistically significant. The median overall survival time was 40 months in laparoscopic group and 41 in open group. The 1-, 2- and 3-year survival rate was 90.2%, 80.4%, 68.6%, respectively in laparoscopic group and 90.0%, 82.0%, 66.0% in open group. The median disease-free survival time was 29 months in laparoscopic group and 31 in open group. The 1-,2- and 3-year recurrence rate was 19.6%,45.1%, and 54.9%, respectively in laparoscopic group and 22.0%,42.0% and 50.0% in open group. Conclusion Laparoscopic partial left liver resection is safe and feasible, and has similar effect on prognosis of patients with hepatocellular carcinoma. When Compared with open surgery, and laparoscopic surgery have some advantages, including minimally invasive, faster recovery, shorter hospital stay and lower cost.