腹腔镜肝切除术治疗84例大肝癌的临床疗效

Clinical efficacy of laparoscopic hepatectomy for the treatment of large hepatocellular carcinoma: a report of 84 cases

    摘要
  • 摘要: 目的:探讨腹腔镜肝切除术治疗大肝癌的临床疗效。
    方法:回顾性分析2009年1月至2011年1月第三军医大学西南医院采用腹腔镜肝切除术治疗84例大肝癌患者的临床资料。术前CT检查显示肿瘤位于左半肝12例、肝左外叶9例、右半肝3例、肝右前叶11例、肝右后叶11例、肝Ⅴ段8例、肝Ⅵ段6例、肝Ⅶ段6例、肝Ⅴ和Ⅵ段8例、肝Ⅶ和Ⅷ段4例、肝Ⅳ段5例、肝Ⅰ段1例。术前超声造影检查结果显示：肿瘤直径为5.1～6.0 cm 46例、6.1～7.0 cm 12例、7.1～8.0 cm 9例、8.1～9.0 cm 7例、9.1～10.0 cm 10例。根据术前评估肿瘤大小、位置、肿瘤距肝脏表面的距离及与重要管道结构的关系及术中探查结果选择性行解剖性或非解剖性肝切除术。患者术后行腹部影像学和血清学复查，复查时间为术后第1年每3个月1次，第2年每4个月1次，第3年每6个月1次，随访时间截至2014年1月。采用KaplanMeier法计算生存率。
    结果:84例患者中8例中转开腹手术，中转开腹率为9.5%(8/84)，76例成功施行腹腔镜肝切除术。30例患者行解剖性肝切除术，54例患者行非解剖性肝切除术。患者手术时间为(240±132)min，术中出血量为(432±340)mL，围手术期输血率为10.7%(9/84)，肿瘤直径为(6.5±1.5)cm，切缘距肿瘤距离为(1.6±0.9)cm，术后胃肠道功能恢复时间为(3.0±0.5)d，术后住院时间为(11±3)d，术后并发症发生率为19.0%(16/84)。术后病理检查结果均为肝细胞癌，其中高分化癌18例、中分化癌57例、低分化癌9例。83例患者(除1例围手术期死亡患者)获得随访，随访时间为2～48个月，中位随访时间为24个月。术后1、3年总体生存率分别为91%、80%，术后1、3年无瘤生存率分别为70%和56%。
    结论:腹腔镜肝切除术选择性应用于大肝癌患者安全、可行，近期疗效好。

     

    Abstract: Objective:To investigate the clinical efficacy of laparoscopic hepatectomy for the treatment of large hepatocellular carcinoma (HCC).
    Methods:From January 2009 to January 2011, 84 patients with large hepatocellular carcinoma received laparoscopic hepatectomy at the Southwest Hospital, and their clinical data were retrospectively analyzed. Lesions were located at the left lobe in 12 cases, left lateral lobe in 9 cases, right lobe in 3 cases, right posterior lobe in 11 cases, right anterior lobe in 11 cases, segment Ⅴ in 8 cases, segment Ⅵ in 6 cases, segment Ⅶ in 6 cases, segment Ⅴ/Ⅵ in 8 cases, segment Ⅶ/Ⅷ in 4 cases, segment Ⅳ in 5 cases and segment Ⅰ in 1 case. According to the results of preoperative ultrasonography, the tumor diameter ranged between 5.1 -6.0 cm in 46 cases, 6.1 7.0 cm in 12 cases, 7.1 -8.0 cm in 9 cases, 8.1 -9.0 cm in 7 cases, 9.1 -10.0 cm in 10 cases. Anatomical or non anatomical hepatectomy was performed according to the results of preoperative assessment and operative exploration. Abdominal imaging examination and serologic examination were done once every 3 months at postoperative year 1, once every 4 months at postoperative year 2, once every 6 months at postoperative year 3. The follow up ended in January 2014. The survival rate was calculated by Kaplan Meier method.
    Results:Eight patients were converted to laparotomy, and the rate of conversion to laparotomy was 9.5%(8/84). Seventy six patients received laparoscopic hepatectomy, including 30 patients received anatomical hepatectomy and 54 received non anatomical hepatectomy. The operation time, volume of blood loss, perioperative blood transfusion rate, tumor diameter, resection margin, time for gastriontestinal function recovery, duration of postoperative hospital stay, incidence of postoperative complications were (240±132)minutes, (432±340)mL, 10.7%(9/84), (6.5±1.5)cm, (1.6±0.9)cm, (3.0±0.5)days, (11±3)days and 19.0%(16/84), respectively. All the patients were comfirmed with HCC including 18 cases of high differentiated HCC, 57 cases of moderate differentiated HCC and 9 cases of low differentiated HCC. One patient died perioperatively. Eighty three patients were followed up for 2 -48 months, the median follow up time was 24 months,and the overall 1 and 3 year survival rates and the 1 and 3 year tumor free survival rates were 91%, 80%, 70% and 56%, respectively.
    Conclusion: Laparoscopic hepatectomy is safe and feasible for selected patients with large hepatocellular carcinoma.

     

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