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背景和目的根据文献报告,腹腔镜肝脏切除术是一种安全有效的肝癌治疗方案。然而,对比传统开腹手术与腹腔镜肝脏切除术在肿瘤复发以及患者生存时间方面的相关研究却不多。本研究旨在分析腹腔镜肝脏切除术与开放手术在肝癌患者生存转归的影响。方法本研究为回顾性病例对照研究。2002年12月至2009年9月间,在600例肝细胞癌(HCC)切除患者中,有32例接受单纯腹腔镜肝脏切除,中位年龄59.5岁。对应这些患者的肿瘤分期、体积、部位以及切除的肝脏体积,找到同期对照的开放肝切除HCC患者64例。开放手术均由富有经验的肝胆外科医生施行,而腹腔镜手术由同一组医生施行。两组均参照Brisbane 2000分类方法施行肝癌切除术,切缘1 cm或以上。统计分析两组间手术短期疗效、手术并发症发生率、无病生存时间以及总生存时间。结果经病理证实,腹腔镜组有28例(87.5%)患者伴肝硬化;开放组有51例(79.7%)患者伴肝硬化。两组肝炎病毒携带率、肝硬化发生率和肝功能情况均良好配对。腹腔镜组肿瘤体积平均2.5 cm(1~10 cm),开放组3 cm(1~10 cm);病理分期I+II期患者比例分别为96.9%和93.7%。此外,两组患者接受肝切除方式的比例完全一致:25%施行肝外叶切除,3.1%施行肝段切除,71.9%施行亚段切除。腹腔镜组,26例(81%)完成了全腔镜操作,其余6例术中改手辅助。腹腔镜手术组与开放手术组的手术时间分别为232.5分钟与204.5分钟(P=0.938),失血量分别为150 ml与300 ml(P=0.001),住院时间分别为4天(2~16天)与7天(4~42天)(P<0.0001),分别有2例(6.3%)及12例(18.8%,9例为胸腔积液)患者出现术后并发症(P=0.184)。两组5年生存率分别为76.6%和57%(P=0.142);无病生存期分别为78.5个月与29个月(P=0.086),总生存期分别为92个月与71个月(P=0.142)。两组中Ⅱ期HCC患者的无病生存期分别为22.1个月以及12.4个月(P=0.075)。结论选择合适的患者实施腹腔镜肝脏切除术治疗HCC,对比开放手术,可获得较低失血量、较短住院时间以及较少术后并发症的良好结果,且不影响患者的长期生存。
Background and purpose According to the literature, laparoscopic liver resection is a safe and effective treatment of liver cancer. However, few studies have compared the traditional laparoscopic and laparoscopic liver resection in tumor recurrence and patient survival time. The purpose of this study was to analyze the impact of laparoscopic liver resection and open surgery on the survival of patients with liver cancer. Methods This study is a retrospective case-control study. Between December 2002 and September 2009, 32 of the 600 HCC resections received a simple laparoscopic liver resection, with a median age of 59.5 years. Corresponding to these patients tumor staging, size, location and resection of the liver volume, find the same period control in 64 cases of open liver resection HCC patients. Open surgery is performed by an experienced hepatobiliary surgeon, while laparoscopic surgery is performed by the same group of doctors. Both groups were performed liver cancer resection according to the Brisbane 2000 classification method with a margin of 1 cm or more. Statistical analysis of short-term efficacy of surgery between two groups, the incidence of surgical complications, disease-free survival time and overall survival time. Results Pathologically, 28 patients (87.5%) in the laparoscopic group had cirrhosis and 51 (79.7%) patients in the open group had cirrhosis. Two groups of hepatitis virus carrying rate, the incidence of cirrhosis and liver function were well matched. In the laparoscopic group, the mean tumor volume was 2.5 cm (1 to 10 cm) in the open group and 3 cm (1 to 10 cm) in the open group. The proportion of patients in stage I and II was 96.9% and 93.7%, respectively. In addition, the two groups of patients underwent hepatectomy in exactly the same proportions: 25% underwent extrahepatic lobectomy, 3.1% underwent hepatectomy, and 71.9% underwent subtotal resection. Laparoscopic group, 26 cases (81%) completed the endoscopic operation, and the remaining 6 cases assisted surgery. Operative time was 232.5 minutes and 204.5 minutes (P = 0.938), laparoscopic surgery group and open surgery group were 150 ml and 300 ml respectively (P = 0.001), hospitalization time was 4 days (2 to 16 days ) And 7 days (4 to 42 days) (P <0.0001). Postoperative complications occurred in 2 patients (6.3%) and 12 patients (18.8%, 9 patients with pleural effusion), respectively. The 5-year survival rates of the two groups were 76.6% and 57%, respectively (P = 0.142). The disease-free survival rates were 78.5 months and 29 months (P = 0.086), respectively. The overall survival rates were 92 months and 71 months (P = 0.142). The disease-free survival of patients with stage II HCC in both groups was 22.1 months and 12.4 months, respectively (P = 0.075). Conclusions Choosing the right patient for laparoscopic hepatectomy for the treatment of HCC, compared with open surgery, can obtain low blood loss, shorter hospital stay and less postoperative complications, good results, and does not affect the long-term survival of patients.