摘要
目的探讨腹腔镜前入路右半肝切除治疗肝细胞癌(肝癌)的安全性及疗效。方法回顾性分析2014年2月至2019年10月在佛山市第一人民医院行右半肝切除的30例肝癌患者临床资料。其中男28例,女2例;年龄24~74岁,中位年龄51岁。根据手术方式将患者分为腹腔镜前入路右半肝切除组(腹腔镜组,11例)和开腹前入路右半肝切除组(开腹组,19例)。患者均签署知情同意书,符合医学伦理学规定。两组手术时间、术后住院时间比较采用t检验,术中出血量比较采用秩和检验,术后并发症发生率比较采用Fisher确切概率法。结果两组均顺利完成手术,无围手术期死亡。腹腔镜组术中出血量中位数为300(200~400)ml,明显少于开腹组的500(300~600)ml(Z=-2.539,P<0.05)。腹腔镜组和开腹组平均手术时间分别为(361±57)、(322±62)min,差异无统计学意义(t=1.739,P>0.05)。腹腔镜组术后住院时间为(8.8±1.3)d,明显短于开腹组的(13.0±6.4)d(t=-1.974,P<0.05)。腹腔镜组术后发生胸腔积液、胆漏分别为6、1例,开腹组相应为9、0例,差异无统计学意义(P=0.705,0.686)。结论腹腔镜前入路右半肝切除治疗肝癌是安全可行的,能明显减少术中出血量,加速患者术后康复。
Objective To evaluate the safety and clinical efficacy of laparoscopic right hemihepatectomy via anterior approach in the treatment of hepatocellular carcinoma(HCC).Methods Clinical data of 30 patients with HCC who underwent right hemihepatectomy in the First People's Hospital of Foshan from February 2014 to October 2019 were retrospectively analyzed.Among them,28 patients were male and 2 female,aged 24-74 years,with a median age of 51 years.According to the surgical methods,all patients were divided into the laparoscopic right hemihepatectomy via anterior approach group(laparoscopic group,n=11)and open right hemihepatectomy via anterior approach group(open group,n=19).The informed consents of all patients were obtained and the local ethical committee approval was received.The operation time and length of postoperative hospital stay between two groups were compared by t test.Intraoperative blood loss was statistically compared by rank-sum test.The incidence of postoperative complications was compared by Fisher's exact test.Results All patients successfully completed the surgery without perioperative death.In the laparoscopic group,the median intraoperative blood loss was 300(200-400)ml,significantly less than 500(300-600)ml in the open group(Z=-2.539,P<0.05).The average operation time in the laparoscopic and open group was(361±57)min and(322±62)min respectively,where no significant difference was observed(t=1.739,P>0.05).In the laparoscopic group,the length of postoperative hospital stay was(8.8±1.3)d,significantly shorter than(13.0±6.4)d in the open group(t=-1.974,P<0.05).In the laparoscopic group,6 cases developed postoperative pleural effusion and 1 case bile leakage,and accordingly 9 cases and 0 in the open group,and no significant difference was observed between two groups(P=0.705,0.686).Conclusions Laparoscopic right hemihepatectomy via anterior approach isa safe and feasible treatment for HCC,which can significantly reduce the intraoperative blood loss and accelerate postoperative rehabilitation of HCC
作者
符荣党
陈焕伟
王峰杰
邓斐文
李杰原
麦结珍
张晓红
Fu Rongdang;Chen Huanwei;Wang Fengjie;Deng Feiwen;Li Jieyuan;Mai Jiezhen;Zhang Xiaohong(Department of Infectious Diseases,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Liver Surgery,the First People's Hospital of Foshan,Foshan 528000,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2020年第6期552-556,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
2016年高校和医院科研基础平台项目(2016AG100561)
广东省医学科研基金项目(A2017387,A2018145)。
关键词
癌
肝细胞
肝切除术
腹腔镜
前入路
Carcinoma,hepatocellular
Hepatectomy
Laparoscopes
Anterior approach
