摘要
目的比较肝细胞癌患者转化治疗后腹腔镜肝切除与单纯腹腔镜肝切除的安全性及近期预后。方法回顾分析2019年1月至2022年12月中山大学孙逸仙纪念医院行腹腔镜肝切除术的740例肝细胞癌患者资料。最终纳入433例,其中男性364例,女性69例,年龄(57.2±11.1)岁。433例患者中转化治疗(包括介入联合靶向、靶向免疫治疗等)后行腹腔镜肝切除纳入转化切除组(n=36),直接行腹腔镜肝切除纳入单纯切除组(n=397)。经倾向性评分匹配后,转化切除组和单纯切除组各29例。比较匹配后两组术前(肝硬化、肿瘤数目、肿瘤最大径等)、手术(手术时间、术中出血量等)和术后(术后住院时间、术后总引流量、术后并发症等)指标、近期预后。Kaplan-Meier法绘制生存曲线,log-rank检验比较生存率。结果经倾向性评分匹配后两组肝硬化、肿瘤数目、肿瘤最大径等方面比较,差异均无统计学意义(均P>0.05),具有可比性。两组手术时间、术中出血量、术后住院时间、术后总引流量等比较,差异均无统计学意义(均P>0.05)。单纯切除组术后总并发症发生率34.5%(10/29),严重并发症(Clavien-Dindo分级≥Ⅲ级)6.9%(2/29),转化切除组分别为41.4%(12/29)、10.3%(3/29),两组比较差异均无统计学意义(χ^(2)=0.29、0,P=0.588、1.000)。转化切除组和单纯切除组的术后6、12、18个月无复发生存率分别为79.2%、70.7%、70.7%和86.2%、82.8%、79.3%,术后6、12、18个月累积生存率分别为96.4%、89.5%、74.6%和100.0%、96.6%、93.1%,两组比较差异无统计学意义(χ^(2)=1.90、1.91,P=0.168、0.167)。结论初始不可切除肝细胞癌患者转化治疗后行腹腔镜肝切除可获得与单纯腹腔镜肝切除相近的安全性和近期预后。
Objective To compare the safety and short-term prognosis of laparoscopic hepatectomy after conversion therapy versus pure laparoscopic hepatectomy for patients with hepatocellular carcinoma(HCC).Methods A total of 740 patients with HCC undergoing laparoscopic hepatectomy at Sun Yat-sen Memorial Hospital of Sun Yat-sen University between January 2019 and December 2022 were screened for study eligibility,among which 433 patients were eligible,including 364 males and 69 females,aged(57.2±11.1)years.Patients who underwent laparoscopic hepatectomy after conversion therapy(including interventional therapy combined with targeted therapy or targeted therapy combined with immunotherapy,etc.)were marked as conversion resection group(n=36),and those who underwent laparoscopic hepatectomy alone were marked as pure resection group(n=397).After propensity score matching(PSM),29 cases in the conversion resection group and pure resection group were finally enrolled.Preoperative(tumor number,maximum tumor diameter,etc.),intraoperative(operation time,intraoperative blood loss,etc.)and postoperative(hospital stay,drainage volume,complications,etc.)data and short-term prognosis were compared between the two groups.Survival curves and rates were analyzed using Kaplan-Meier and log-rank test.Results The baseline characteristics including the occurrence of liver cirrhosis,the tumor number and maximum diameter showed no significant differences between the two groups after PSM(all P>0.05),indicating comparability.There were no statistical differences between the two groups in terms of operation time,intraoperative blood loss,postoperative hospital stay,postoperative drainage volume etc.(all P>0.05).The incidences of postoperative complications and severe complications(Clavien-Dindo grade≥Ⅲ)were 34.5%(10/29)and 6.9%(2/29)in pure resection group,and 41.4%(12/29)and 10.3%(3/29)in conversion resection group,respectively,with no significant difference between the two groups(χ^(2)=0.29,0,P=0.588,1.000).The recurrence-free survival rates
作者
龙吟
蓝然
何晓东
张磊
Long Yin;Lan Ran;He Xiaodong;Zhang Lei(Department of Hepatobiliary Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510220,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2023年第7期493-498,共6页
Chinese Journal of Hepatobiliary Surgery
关键词
癌
肝细胞
腹腔镜检查
倾向性评分
转化治疗
Carcinoma,hepatocellular
Laparoscopy
Propensity score
Conversion therapy
