摘要
目的比较超重/肥胖肝细胞癌(HCC)患者腹腔镜肝切除(LLR)与开腹肝切除(OLR)术后教科书式结局(TO)的差异,探索影响超重/肥胖HCC患者肝切除术后获得TO的危险因素。方法回顾性分析四川大学华西医院和资阳市中心医院2014—2023年间行初次肝切除术的超重/肥胖HCC患者的病例资料。按手术方式不同分为LLR组和OLR组。采用倾向性得分匹配(PSM)方法对LLR组和OLR组间差异基线特征进行平衡。比较两组PSM前后TO获得率及TO包含的7项指标差异。采用Logistic回归分析影响患者术后获得TO的独立危险因素。结果本研究共纳入1277例超重/肥胖HCC患者,LLR组(n=328)和OLR组(n=949)患者基线特征存在明显差异,PSM后两组各纳入326例患者。PSM前,1277例患者中共831(65.1%)例患者获得TO;LLR组TO实现率高于OLR组(75.6%vs 61.4%,χ^(2)=21.555,P<0.001)。PSM后,LLR组TO实现率仍显著高于OLR组(75.8%vs 68.7%,χ^(2)=4.046,P=0.044);TO包含的7项指标中,LLR组住院时间延长的患者比例显著低于OLR组(15.0%vs 25.8%,χ^(2)=11.571,P<0.001);两组患者术后30 d内严重并发症发生率、术后90 d内死亡率、围手术期输血率、非R0切除比例、出院后30 d内再入院率差异均无统计学意义(P>0.05)。Logistic回归分析显示,白蛋白-胆红素评分为2级(OR=1.989,95%CI 1.527-2.591,P<0.001)、肿瘤最大径>5 cm(OR=1.685,95%CI 1.315-2.160,P<0.001)、微血管侵犯(OR=1.377,95%CI 1.070-1.773,P=0.013)、肿瘤低分化(OR=1.463,95%CI 1.021-2.097,P=0.038)、OLR(OR=1.680,95%CI 1.250-2.257,P<0.001)是影响患者术后获得TO的独立危险因素。结论对于超重/肥胖HCC患者,LLR较OLR术后TO获得率更高。该优势主要得益于LLR术后住院时间延长的患者比例明显低于OLR。OLR是影响超重/肥胖HCC患者术后获得TO的独立危险因素,对于拟行肝切除术的超重/肥胖的HCC患者应优先考虑LLR。
Objective To compare the textbook outcomes(TO)between laparoscopic liver resection(LLR)and open liver resection(OLR)in overweight or obese hepatocellular carcinoma(HCC)patients.To analyze the risk factors for TO after hepatectomy in overweight or obese patients with HCC.Methods The clinical data of overweight or obese HCC patients who underwent primary liver resection at West China Hospital and Ziyang Central Hospital from 2014 to 2023 were retrospectively analyzed.Based on the surgical approach,patients were divided into the LLR group and the OLR group.Propensity score matching(PSM)was used to balance baseline characteristics between the two groups.The TO achievement rate and each item of TO were compared between the two groups.Logistic regression was used to analyze the independent risk factors for postoperative TO.Results A total of 1277 patients were enrolled in this study,of whom 949(74.3%)patients received OLR and 328(25.7%)patients received LLR.Among the 1277 patients,831(65.1%)patients achieved TO.Befor PSM,the TO achievement rate in the LLR group was significantly higher than that in the OLR group(75.6%vs 61.4%,χ^(2)=21.555,P<0.001).After PSM,the TO achievement rate in the LLR group was significantly higher than that in OLR group(75.8%vs 68.7%,χ^(2)=11.571,P=0.044);Further analysis indicated that the proportion of patients with prolonged hospitalization time in the OLR group was significantly higher than in the LLR group(25.8%vs 15.0%,P<0.001);The incidence of severe 30-day postoperative complications,mortality within 90 days after surgery,perioperative blood transfusion,non-R0 resection,and re-hospitalization within 30 days after discharge were similar between the two groups(P>0.05).Logistic regression analysis confirmed that,albumin-bilirubin with grade 2(OR=1.989,95%CI 1.527 to 2.591,P<0.001),tumor size>5 cm(OR=1.685,95%CI 1.315 to 2.160.P<0.001),microvascular invasion(OR=1.377,95%CI 1.070 to 1.773,P=0.013),poor tumor differentiation(OR=1.463,95%CI 1.021 to 2.097,P=0.038)and OLR(OR=1.680,95%CI 1.250 to 2.257,P<0.001)were independent risk factors for non-TO after liver resection.Conclusion For overweight or obese HCC patients,LLR offered an advantage in TO achievement than OLR.This advantage was mainly attributed to lower proportion of prolonged hospitalization time after LLR.OLR was an independent risk factor for overweight or obese HCC patients to achieve TO after surgery.LLR should be considered as a priority for overweight or obese patients with HCC.
作者
董文文
覃莉
邱占成
周颖
陈廷昊
李川
DONG Wenwen;QIN Li;QIU Zhancheng;ZHOU Ying;CHEN Tinghao;LI Chuan(Department of General Surgery,West China Hospital of Sichuan University,Chengdu,Sichuan 610041,China;Department of Hepatobiliary and Pancreatic Surgery,Ziyang Central Hospital,Ziyang,Sichuan 641399,China)
出处
《肝胆胰外科杂志》
2025年第8期505-510,共6页
Journal of Hepatopancreatobiliary Surgery
基金
四川省自然科学基金(2024NSFSC0637)。
关键词
肝细胞癌
腹腔镜肝切除
开腹肝切除
教科书式结局
危险因素
hepatocellular carcinoma
laparoscopic liver resection
open liver resection
textbook outcome
risk factor
