腹腔镜循肝中静脉半肝切除术在原发性肝癌中的应用

目的 探讨腹腔镜循肝中静脉的半肝切除术治疗原发性肝癌的可行性、安全性及临床疗效。方法 采用回顾性横断面研究方法。纳入2012年3月—2015年3月重庆医科大学附属第二医院和遂宁市中心医院肝胆外科采用腹腔镜循肝中静脉半肝切除术治疗原发性肝癌患者135例,其中男89例、女46例,年龄17~71岁,左半肝切除73例、右半肝切除62例。术后观察患者中转开腹率、手术时间、术中出血量、术中输血率、术后并发症、术后住院时间、术后总体生存率和无瘤生存率。结果 135例中,5.2%(7/135)中转开腹,手术时间为(315±86) min,术中出血量为(513±162) mL。5.9%(8/135)术中输血;12.6%(17/135)发生术后并发症,其中8.1%(11/135)为Clavien分级Ⅰ级、3.0%(4/135)为Clavien分级Ⅱ级、1.5%(2/135)例为Clavien分级Ⅲ~Ⅴ级;无死亡病例。116例纳入生存分析,中位随访时间34个月,1、3、5年总体生存率分别为92.6%、76.8%和64.4%,1、3、5年无瘤生存率分别为88.3%、69.2%和54.9%。结论 在有经验的肝脏外科中心行腹腔镜下循肝中静脉的半肝切除术的风险可控,并发症少,疗效确切。

The application of laparoscopic precise hemihepatectomy guided by middle hepatic vein in the treatment of primary liver cancer

Objective To evaluate the feasibility, safety and clinical efficacy of laparoscopic precise hemihepatectomy guided by middle hepatic vein in the treatment of primary liver cancer.Methods Retrospective cross-sectional study was adopted. The clinical and pathologic data of patients undergoing laparoscopic precise hemihepatectomy guided by middle hepatic vein at the Second Affiliated Hospital of Chongqing Medical University and Suining Central Hospital from March 2012 to March 2015 were analyzed. There were 89 males and 46 females aged from 17-71 years, including 73 patients of left hepatectomy and 62 patients of right hepatectomy. Conversion to laparotomy, operative time, intraoperative blood loss, intraoperative blood transfusion rate, postoperative complications, postoperative hospital stay, postoperative overall survival rate and recurrence-free survival rate were calculated.Results A total of 135 patients were included in the study, 5.2% (7/135) patients were converted to laparotomy. The operation time was (315±86) minutes. The intraoperative blood loss was (513±162) mL and 5.9% (8/135) cases needed intraoperative blood transfusion. 12.6% (17/135) cases had postoperative complications, of which 8.2% (11/135) were Clavien Grade Ⅰ, 3.0% (4/135) were Clavien Grade Ⅱ, and 1.5%(2/135) were Clavien Grade Ⅲ-Ⅴ, no deaths. One hundred and sixteen patients were included in the survival analysis. The median follow-up time was 34 months. The overall survival rates at 1, 3 and 5 years were 92.6%, 76.8% and 64.4%, respectively. The recurrence-free survival rates at 1, 3 and 5 years were 88.3%, 69.2% and 54.9%, respectively.Conclusions The risk of laparoscopic precise hemihepatectomy guided by middle hepatic vein in an experienced liver surgery center is controllable, with fewer complications and a definite curative effect.