摘要
目的对比腹腔镜肝切除与开放肝切除术对原发性大肝癌患者近、远期疗效。方法回顾性分析2011年11月至2021年12月安徽医科大学第一附属医院收治的手术切除并经病理证实肿瘤直径>5cm的肝细胞癌患者的临床病理资料。根据手术方式分为开腹组(n=50)和腔镜组(n=48)。对比分析两组患者手术时间、术中出血量、术后并发症发生率、术后引流时间和术后住院时间等围术期情况及复发、生存等远期预后情况。结果(1)两组患者基线资料均衡可比,差异均无统计学意义(P>0.05)。(2)围术期情况:两组患者在手术时间、术中出血量、严重并发症(Clavien-Dindo≥Ⅲ级)发生率等方面差异无统计学意义(P>0.05),但腔镜组术后引流时间、术后住院时间显著短于开腹组(P<0.05);腔镜组术后并发症总发生率(6.25%)显著低于开放组(24.00%)(P<0.05);(3)远期预后情况:两组患者在中位无病生存时间[开放组:15个月(95%CI:3.868~26.132)vs.腔镜组26个月(95%CI:21.983~30.017)]、2年复发率(开放组:62.00%vs.腔镜组56.25%)、中位总生存期[开放组:25个月(95%CI:14.214~35.786)vs.腔镜组:43个月(95%CI:26.236~59.764)]、5年总生存率(开放组:36%vs.腔镜组43.75%)等方面无显著差异(P>0.05)。结论腹腔镜肝切除治疗大肝癌患者具有更好的近期临床疗效,且患者的远期预后与开腹肝切除相当,腹腔镜肝切除治疗大肝癌患者安全可行.
Objective To compare the short-term and long-term efficacy of laparoscopic liver resection and open liver resection in patients with primary large liver cancer.Methods The clinical and pathological data of patients with hepatocellular carcinoma who underwent surgical resection and were pathologically confirmed to have a tumor diameter>5 cm from November 2011 to December 2021 at the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed.The patients were divided into the open surgery group(n=50)and the laparoscopic group(n=48)based on the surgical approach.The perioperative conditions such as operation time,intraoperative blood loss,postoperative complication rate,postoperative drainage time,and postoperative hospital stay,as well as the long-term prognosis such as recurrence and survival,were compared and analyzed between the two groups.Results(1)The baseline data of the two groups of patients were balanced and comparable,with no statistically significant differences(P>0.05).(2)Perioperative conditions:There were no statistically significant differences between the two groups in terms of operation time,intraoperative blood loss,and the incidence of severe complications(Clavien-Dindo≥Ⅲ)(P>0.05).However,the postoperative drainage time and postoperative hospital stay in the laparoscopic group were significantly shorter than those in the open group(P<0.05).The total incidence of postoperative complications in the laparoscopic group(6.25%)was significantly lower than that in the open group(24.00%)(P<0.05).(3)Long-term prognosis:There were no significant differences between the two groups in terms of median disease-free survival time[open group:15 months(95%Cl:3.868-26.132)vs.laparoscopic group:26 months(95%CI:21.983-30.017)],2-year recurrence rate(open group:62.00%vs.laparoscopic group:56.25%),median overall survival time[open group:25months(95%CI:14.214-35.786)vs.laparoscopic group:43 months(95%CI:26.236-59.764)],and 5-year overall survival rate(open group:36%vs.laparoscopic group:43.75%)(P>0.05).Conclusions Laparoscopic liver resection for patients with large liver cancer has better short-term clinical efficacy,and the long-term prognosis of these patients is comparable to that of open liver resection.Laparoscopic liver resection for patients with large liver cancer is safe and feasible.
作者
梁谭
陈子祥
陈江明
刘付宝
LIANG Tan;CHEN Zi-xiang;CHEN Jiang-ming(Department of General Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
出处
《肝胆外科杂志》
2025年第5期352-357,共6页
Journal of Hepatobiliary Surgery
基金
安徽省卫生健康科研项目重点课题(AHWJ2023A10028)。
关键词
大肝癌
肝细胞肝癌
腹腔镜
开腹
术后住院时间
远期疗效
large liver cancer
hepatocellular carcinoma
laparoscopy
open surgery
postoperative hospital-stay duration
long-term efficacy
