腹腔镜下非边缘部位小肝癌切除34例临床分析

目的探讨腹腔镜肝切除术在治疗非边缘部位小肝癌中的临床应用价值。方法对笔者所在医院2008年3月至2011年4月期间34例行腹腔镜肝切除术的非边缘部位小肝癌患者的临床资料进行回顾性分析。结果 34例患者中32例在不阻断肝血流情况下完成腹腔镜肝切除术,2例中转开腹。手术时间为(162±65)min(100～220 min),术中出血量为(295±166)ml(100～750 ml)。术后并发肝创面出血2例、腹水2例,无胆瘘、感染、CO2气栓等并发症发生,无围手术期死亡病例。术后住院时间为(6±2)d(4～9 d)。术后随访(23±7)个月(5～42个月),13例出现肝内非原位复发,术后1年生存率为90.6%(29/32),无瘤生存率为75.0%(24/32)。结论腹腔镜肝切除对部分非边缘部位小肝癌是一种安全有效的微创治疗方法,可考虑作为肝癌治疗的选择术式之一。

Clinical Analysis on Laparoscopic Hepatectomy for 34 Patients with Small Hepatocellular Carcinoma of Non-Peripheral Type

Objective To explore the value of laparoscopic hepatectomy for small hepatocellular carcinoma(HCC) of non-peripheral type.Methods The clinical data of 34 patients with small HCC of non-peripheral type underwent laparoscopic liver resection from March 2008 to April 2011 in our hospital were analyzed retrospectively.Results Thirty-two patients received successful total laparoscopic hepatectomy without blockage of liver blood flow,and 2 were converted to open surgery.The operative time was(162±65) min(100-220 min) and the blood loss was(295±166) ml(100-750 ml).There were postoperative complications in 4 patients,included cross-section bleeding in 2 cases and ascites in 2 cases.There were no complications such as biliary fistula,infection,carbon dioxide gas embolism,and so on.The mortality of perioperative period was 0.The postoperative hospital stay was(6±2) d(4-9 d). The follow-up time was(23±7) months(5-42 months).Thirteen patients developed intrahepatic tumor recurrence during follow-up.The overall and recurrence-free survival rate one year after operation was 90.6%(29/32)and 75.0%(24/32),respectively.Conclusions Laparoscopic hepatectomy is a safe,feasible,and minimal invasive approach for small HCC of non-peripheral type,and it can be considered as a alternative treatment of HCC.