【摘要】 目的探讨腹腔镜肝切除术(laparoscopic liver resection,LLR)治疗肝母细胞瘤(hepatoblastoma,HB)的安全性及可行性。方法收集2012年1月至2019年5月在西安交通大学第二医院接受LLR和开腹肝切除术(open liver resection,OLR)的HB患儿临床资料并进行回顾性分析,比较术前资料、手术指标、围手术期并发症及术后随访结果。结果符合入选标准的LLR患儿17例(为LLR组),OLR患儿26例(为OLR组),两组患儿在年龄、性别、血红蛋白、肝功能、甲胎蛋白、肿瘤位置、大小、数目及手术方式、PRETEXT分期、危险度分层等方面均无统计学差异(P> 0. 05)。与OLR组相比,LLR组手术时间更长[LLR组(246±47. 4) min vs. OLR组(187±52. 8) min,P <0. 01],术中出血量更少[LLR组(77. 5±39. 2) m L vs. OLR组(110. 6±34. 5) m L,P <0. 01],手术切口长度更短[LLR组(6. 0±2. 4) cm vs. OLR组(10. 7±3. 1) cm,P <0. 01]。两组均获R0期切除且无一例围手术期死亡病例。术后LLR组肝功能恢复更快[术后第7天AST:LLR组(64. 7±20. 5) IU/L vs. OLR组(77. 8±17. 6) IU/L,P<0. 05;术后第7天ALT:LLR组(72. 2±16. 3) IU/L vs. OLR组(86. 4±23. 2) IU/L,P <0. 05],镇静剂或止痛药使用次数更少[LLR组(3. 3±1. 0)次vs. OLR组(4. 8±0. 7)次,P <0. 01],术后禁食时间[LLR组(1. 5±0. 6) d vs. OLR组(2. 8±0. 5) d,P <0. 01]及住院时间[LLR组(7. 3±1. 3) d vs. OLR组(10. 6±2. 1) d,P <0. 01]更短。两组患儿术后严重并发症发生率(LLR组11. 8%vs. OLR组11. 5%)、再手术率(LLR组5. 9%vs. OLR组3. 8%)、肿瘤复发转移率(LLR组17. 6%vs. OLR组19. 2%)、3年无瘤存活率(LLR组75. 0%vs. OLR组76. 9%)均无显著性差异(P> 0. 05)。结论采用LLR治疗HB安全可行,具有出血量少、创伤小、恢复快、切口美观的优点,且不会增加术后并发症发生率,近期疗效尚可,但远期疗效有待进一步观察。更多还原

【Abstract】 Objective To explore the safety,feasibility and short-term outcome of laparoscopic versus open liver resection( LLR vs OLR) for hepatoblastoma( HB). Methods The perioperative and follow-up data of LLR( n = 17) and OLR( n = 26) for HB operations at the same period were analyzed respectively from January 2012 to May 2019. Results No significant inter-group differences existed in age,gender,hemoglobin concentration,liver function,alpha fetoprotein( AFP) level and size/number/location/PRETEXT stage of tumor( P > 0. 05). As compared with OLR group,estimated blood loss was less and mean operative time longer in LLR group( P < 0. 01). No perioperative mortality occurred in neither groups and all of them underwent R0 resection. After operation,liver function recovered more quickly( Day 7 post-operation,AST: LLR 64. 7; 20. 5 vs OLR 77. 8 ± 17. 6 IU/L,P < 0. 05; ALT: LLR 72. 2 ± 16. 3 vs OLR 86. 4 ± 23. 2 IU/L,P < 0. 05). Fasting time and length of stay were much shorter( P < 0. 01) in LLR group with less sedatives or painkillers needed( P < 0.01). No inter-group difference existed in the incidence of severe complications( P > 0. 05). The 3-year eventfree survival was 75. 0% for LLR and 76. 9% for OLR. No inter-group difference existed. The reoperative rate was 5. 9% for LLR and 3. 8% for OLR respectively( P > 0. 05). Conclusion As a safe and feasible option for pediatric HB,LLR offers the advantages of minimal intraoperative trauma,faster recovery and no higher incidence of postoperative complications. And its short-term outcome is similar to that of OLR. However,long-term outcomes should be further evaluated.更多还原