【作者】 王俊；

【导师】 黄明文；

【作者基本信息】 南昌大学 ， 临床医学硕士（专业学位）， 2023， 硕士

【摘要】 目的:本研究的目的在于比较腹腔镜下肝切除术(Laparoscopic hepatectomy,LH)与开放肝切除术(Open hepatectomy,OH)治疗中央区肝细胞癌(Central located hepatocellular carcinoma,CL-HCC)的优劣势,探讨腹腔镜下肝切除术在治疗中央区肝细胞癌临床实践中的安全性与可行性。方法:收集2016年1月至2022年5月于南昌大学第二附属医院肝胆外科接受腹腔镜下肝切除术与开放肝切除术的38例中央区肝细胞癌患者的临床资料,其中腹腔镜下肝切除术15例,设为腹腔镜组(LH组);开放肝切除术23例,设为开放组(OH组)。所有患者均已签署相关手术知情同意书,实验符合医学伦理学规定。以两组患者的术前一般情况(性别、年龄、Child-Pugh分级因素、既往上腹部手术史、病灶最大直径、既往基础疾病史、肝硬化病史及乙肝病史);术中指标(手术时长、术中出血量、输血率、术中手术方式);术后观察指标(术后肝功能指标、凝血功能指标、术后腹腔引流量、术后住院天数、住院总费用及术后并发症);术后随访等综合作为评估因素,进行统计学分析得出临床研究结论。结果:15名患者接受LH治疗,23名患者接受了OH治疗。腹腔镜组与开放组患者的术前一般情况如年龄、性别、Child-Pugh分级因素、既往基础疾病史、肝硬化病史、乙肝病史及病灶最大直径之间无统计学差异(P>0.05)。腹腔镜下肝切除术患者与开放肝切除术患者相比,腹腔镜下肝切除术患者较开放肝切除术患者术中出血量更少(P<0.001)、术后住院时间更短(P<0.001),而两组手术时长(P=0.115)、输血率(P=1.000)与住院总费用(P=0.057)无统计学差异。两组患者术后第1天的谷草转氨酶、总胆红素与凝血酶原时间较术前均有上升,但两组结果无统计学差异(P>0.05);LH组与OH组术后第1天白蛋白较术前均有所降低,且两组无统计学差异(P>0.05);术后第3天复查生化及凝血功能,两组患者的肝功能指标与凝血功能指标均呈恢复趋势,两组数据无统计学差异(P>0.05)。LH组术后并发症总发生率较OH组低(6.7%vs 21.7%,P=0.370),但无统计学差异,胆漏、切口愈合不良、胸腔积液、术后腹腔出血、术后急性肝衰竭、术后死亡等并发症发生率均无统计学差异(P>0.05)。两组患者术后均未出现严重并发症如术后腹腔出血、急性肝衰竭及手术后死亡;通过术后随访使用Kaplan-Meier法计算患者术后的3年总体生存率,两组并无统计学差异(P>0.05)。结论:腹腔镜下肝切除术对治疗中央区肝细胞癌是安全、可行的,LH治疗中央区肝细胞癌具有手术切口小,术后恢复快等优点。与OH相比在减少术中出血、缩短术后住院天数方面具有明显的优势。更多还原

【Abstract】 Purpose:The aim of this study is to compare laparoscopic hepatectomy(LH)with open hepatectomy(OH)in the treatment of central located hepatocellular carcinoma(CL-HCC),to explore the safety and feasibility of laparoscopic hepatectomy in the clinical practice of central located hepatocellular carcinoma.Methods: The clinical data of 38 patients with hepatocellular carcinoma in the central region who underwent laparoscopic hepatectomy and open hepatectomy in The Second Affiliated Hospital of Nanchang University from January 2016 to May2022 were collected.Among them,15 patients underwent laparoscopic hepatectomy and were set as the laparoscopic group(LH group).Twenty-three patients underwent open hepatectomy and were set into the open group(OH group).All patients had signed the relevant informed consent for the operation,and the experiment was in accordance with the medical ethics regulations.The preoperative general information of the two groups(gender,age,Child-Pugh grading factor,previous history of upper abdominal surgery,maximum diameter of the lesion,previous history of underlying diseases,history of liver cirrhosis and history of hepatitis B);Intraoperative indicators(operation duration,intraoperative blood loss,blood transfusion rate,intraoperative surgical method);Postoperative observation indexes(postoperative liver function indexes,coagulation function indexes,Postoperative abdominal drainage,postoperative hospitalization days,total hospitalization costs and postoperative complications);Postoperative follow-up and other comprehensive evaluation factors,statistical analysis to draw the conclusion of clinical research.Results: 15 patients treated with LH,23 patients underwent OH.There were no statistically significant differences in preoperative general conditions,such as age,gender,Child-Pugh grading factors,history of underlying diseases,history of cirrhosis,history of hepatitis B,and maximum lesion diameter between laparoscopic and open groups(P >0.05).Compared with open hepatectomy patients,laparoscopic hepatectomy patients had less intraoperative blood loss(P <0.001)and shorter postoperative hospital stay(P <0.001).There were no significant differences in operation duration(P =0.115),blood transfusion rate(P =1.000)and total hospitalization cost(P =0.057)between the two groups.The time of glutamic oxalacetic transaminase,total bilirubin and prothrombin in 2 groups on the first day after surgery was increased compared with that before surgery,but there was no statistical difference between 2 groups(P >0.05).The albumin of LH group and OH group on day 1 after surgery was lower than that before surgery,and there was no statistical difference between the two groups(P >0.05).Biochemical and coagulation function were reviewed on the third day after surgery,and liver function indexes and coagulation function indexes of the two groups showed a recovery trend,with no statistical difference between the two groups(P >0.05).The total incidence of postoperative complications in the LH group was lower than that in the OH group(6.7% vs 21.7%,P =0.370),but there were no statistical differences,and there were no statistical differences in the incidence of complications such as bile leakage,poor wound healing,pleural effusion,postoperative abdominal hemorrhage,postoperative acute liver failure,and postoperative death(P >0.05).No serious complications such as postoperative abdominal bleeding,acute liver failure and postoperative death occurred in both groups.Kaplan-Meier method was used to calculate the 3-year overall survival rate after postoperative follow-up,and there was no statistical difference between the two groups(P >0.05).Conclusions: Laparoscopic hepatectomy is safe and feasible for the treatment of central hepatocellular carcinoma.In the treatment of central hepatocellular carcinoma,LH has the advantages of small incision and quick postoperative recovery.Compared with OH,it has obvious advantages in reducing intraoperative bleeding and shortening postoperative hospitalization days.更多还原