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腹腔镜肝切除术治疗391例肝细胞癌的临床体会
Experience in laparoscopic hepatectomy in treatment of hepatocellular carcinoma
文章发布日期:2018年07月06日  来源:  作者:田州,张建淮,孙喜太,等  点击次数:320次  下载次数:37次

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【摘要】:目的总结腹腔镜肝切除术治疗肝细胞癌的临床体会。方法选取2008年12月-2015年12月南京医科大学附属淮安第一医院、南京大学附属鼓楼医院、徐州医科大学附属医院收治的肝细胞癌患者临床资料。根据手术方式不同分为腹腔镜肝切除术组(LH组,n=391)和开腹肝切除术组(OR组,n=682)。比较两组手术时间、切口大小、术中出血量、术后恢复情况、术后住院时间、手术费用、住院费用及并发症情况等。计量资料两组间比较采用独立样本t检验;计数资料两组间比较采用χ2检验。结果LH组与OR组相比,术中出血量[(165.00±79.21) ml vs (457.00±125.00) ml]、切口长度[(4.07±0.31) cm vs (20.48±2.36) cm]、进食时间[(1.50±0.61) d vs (2.43±0.40) d]、术后下床时间[(1.36±0.31) d vs (4.12+0.82) d]、住院时间[(10.09±352) d vs (15.36±4.57) d]、手术费用[(9471.00±639.73) 元vs (5329.12±461.40) 元]及住院费用[(37.315.17±13.194.78) 元vs (35.007.6±10 611.20)元]差异均有统计学意义(t值分别为41.64、136.80、30.10、63.98、19.70、122.44、3.13,P值均<0.05)。LH组1、3、5年生存率分别为89.42%、64.32%、43.12%,OR组1、3、5年生存率分别为88.11%、61.45%、38.38%,两组生存率比较,差异无统计学意义(P>0.05)。结论腹腔镜肝切除术具有创伤小、术中出血少、恢复快的优点,可缩短住院时间,未增加术后并发症,对于周围型和微小肝癌及左外叶肝肿瘤,建议作为首选治疗方法之一。
【Abstract】:ObjectiveTo summarize the clinical experience in laparoscopic hepatectomy in the treatment of hepatocellular carcinoma (HCC). MethodsThe patients with HCC who were admitted to Huaian No. 1 People′s Hospital Affiliated to Nanjing Medical University, Drum Tower Hospital Affiliated to Nanjing University, and The Affiliated Hospital of Xuzhou Medical Hospital from December 2008 to December 2015 were enrolled and their clinical data were collected. According to the surgical procedure, these patients were divided into laparoscopic hepatectomy group with 391 patients (LH group) and open hepatectomy group with 682 patients (OR group). The two groups were compared in terms of time of operation, incision size, intraoperative blood loss, postoperative recovery, length of postoperative hospital stay, surgery costs, hospital costs, and complications. The independent samples t-test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. ResultsThere were significant differences between the LH group and the OR group in intraoperative blood loss (165.00±79.21 ml vs 457.00±125.00 ml, t=41.64, P<0.05), length of incision (4.07±0.31 cm vs 20.48±2.36 cm, t=136.80, P<0.05), time to diet (1.50±0.61 d vs 2.43±0.40 d, t=30.10, P<0.05), time to ambulation after surgery (1.36±0.31 d vs 4.12+0.82 d, t=63.98, P<0.05), length of hospital stay (10.09±3.52 d vs 15.36±4.57 d, t=19.70, P<0.05), surgery costs (9471.00±639.73 yuan vs 5329.12±461.40 yuan, t=122.44, P<0.05), and hospital costs (37 315.17±13 194.78 yuan vs 35 007.6±10 611.20 yuan, t=3.13, P<0.05). The 1-, 3-, and 5-year survival rates were 89.42%, 64.32%, and 43.12% in the LH group and 88.11%, 61.45%, and 38.38% in the OR group, and there were no significant differences between the two groups (P>0.05). ConclusionLH has the advantages of little trauma, low intraoperative blood loss, fast recovery, and short postoperative hospital stay and does not increase complications. Therefore, it can be used as the primary therapy for peripheral liver cancer, small hepatocellular carcinoma, and liver tumor in the left lateral lobe.
【关键字】:癌,肝细胞; 腹腔镜检查; 肝切除术; 治疗学
【Key words】:carcinoma, hepatocellular; laparoscopy; hepatectomy; therapeutics
【引证本文】:TIAN Z, ZHANG JH, SUN XT, et al. Experience in laparoscopic hepatectomy in treatment of hepatocellular carcinoma[J]. J Clin Hepatol, 2018, 34(8): 1712-1716. (in Chinese)
田州, 张建淮, 孙喜太, 等. 腹腔镜肝切除术治疗肝细胞癌的临床体会[J]. 临床肝胆病杂志, 2018, 34(8): 1712-1716.

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