腹腔鏡肝切除術(shù)治療小肝癌短期療效及無瘤生存率的觀察

黃純軍

【摘要】 目的：探討腹腔鏡肝切除術(shù)治療小肝癌的臨床短期療效及無瘤生存率。方法：選取2014年1月-2015年1月本院收治的90例小肝癌患者，隨機(jī)分為觀察組和對(duì)照組，每組各45例。觀察組行腹腔鏡肝切除術(shù)，對(duì)照組行傳統(tǒng)開腹肝切除術(shù)，觀察兩組短期療效及無瘤生存情況。結(jié)果：90例患者均順利完成手術(shù)，腹腔鏡肝癌切除術(shù)患者無中轉(zhuǎn)開腹情況。觀察組術(shù)中出血量、術(shù)后并發(fā)癥、術(shù)后臥床及住院時(shí)間均顯著少于對(duì)照組（P<0.05）。隨訪2年，觀察組失訪4例，腫瘤無進(jìn)展患者22例，2年無瘤生存率為48.78%，中位無瘤生存率為21.801個(gè)月；對(duì)照組失訪6例，腫瘤無進(jìn)展者16例，2年無瘤生存率35.90%，中位無瘤生存時(shí)間為16.716個(gè)月。經(jīng)Log Rank檢驗(yàn)，兩組中位無瘤生存時(shí)間比較，差異有統(tǒng)計(jì)學(xué)意義（Log Rank=4.505，P=0.034），兩組2年無瘤生存率比較，差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論：經(jīng)腹腔鏡肝切除術(shù)治療小肝癌術(shù)后并發(fā)癥少，恢復(fù)快，有助于延長(zhǎng)小肝癌患者術(shù)后無瘤生存時(shí)間。

【關(guān)鍵詞】 小肝癌； 腹腔鏡肝切除術(shù)； 短期療效； 無瘤生存率

Observation of Short Term Effect and Disease-free Survival Rate of Laparoscopic Liver Resection for Small Hepatocellular Carcinoma/HUANG Chunjun.//Medical Innovation of China，2017，14（32）：126-129

【Abstract】 Objective：To investigate the clinical short-term efficacy and tumor-free survival rate of laparoscopic hepatectomy for small hepatocellular carcinoma.Method：A total of 90 patients with small hepatocellular carcinoma who were enrolled in our hospital from January 2014 to January 2015 were randomly divided into observation group and control group，45 cases in each group.The observation group underwent laparoscopic liver resection，the control group underwent conventional open hepatectomy，the short-term efficacy and tumor-free survival of the two groups were observed.Result：90 cases were successfully completed the operation，laparoscopic hepatocellular carcinoma resection patients without transition to the situation.The intraoperative blood loss，postoperative complications，postoperative bed rest and hospital stay in the observation group were significantly lower than those in the control group（P<0.05）.After 2 years of follow-up，4 cases were lost in the observation group，22 cases without tumor progression，and 2 years without tumor survival rate was 48.78%，the median tumor-free survival rate was 21.801 months，the control group lost 6 cases，the tumor without progress 16 cases，2-year disease-free survival rate of 35.90%，median tumor-free survival time of 16.716 months.By Log Rank test，the median disease-free survival time between the two groups was statistically significant（Log Rank=4.505，P=0.034），there was no significant difference between the two groups in the 2 years disease-free survival rate（P>0.05）.Conclusion：Laparoscopic hepatectomy for small hepatocellular carcinoma has less postoperative complications and quicker recovery， which helps to prolong the disease-free survival time in patients with small hepatocellular carcinoma.

【Key words】 Small hepatocellular carcinoma； Laparoscopic hepatectomy； Short-term efficacy； Tumor-free survival rateendprint

First-authors address：Wuxue First Peoples Hospital，Wuxue 435400，China

doi：10.3969/j.issn.1674-4985.2017.32.032

肝癌是世界范圍內(nèi)最常見的惡性腫瘤，每年約有10萬人死于肝癌，我國(guó)乙肝患者人數(shù)眾多，每年我國(guó)因肝癌死亡的患者約占全世界肝癌總死亡數(shù)的一半[1]。臨床上將單個(gè)腫瘤直徑≤3 cm的肝癌稱之為小肝癌[2]。目前，小肝癌的治療方式主要以開腹手術(shù)和腹腔鏡手術(shù)為主[3]。雖然腹腔鏡手術(shù)具有安全、微創(chuàng)特點(diǎn)，但對(duì)于術(shù)后短期療效和無瘤生存情況，臨床仍然存有一定爭(zhēng)議[4]。鑒于此，本次研究納入2014年1月-2015年1月在本院收治的90例小肝癌患者，比較腹腔鏡肝切除術(shù)和開腹手術(shù)的治療效果，現(xiàn)報(bào)道如下。

1 資料與方法

1.1 一般資料 選取2014年1月-2015年1月本院收治的90例小肝癌患者，納入標(biāo)準(zhǔn)：（1）所有患者經(jīng)病理學(xué)確診為小肝癌，且單個(gè)腫瘤直徑≤3 cm；（2）年齡18～60歲；（3）MRI或CT檢查沒有顯示門靜脈或肝靜脈及其分支侵犯；（4）患者及家屬均簽署治療知情同意書?！?br>