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肝癌全腹腔镜与开腹肝切除术的病例匹配分析:短期和中期结果。

Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results.

机构信息

Department of Surgery, Liver Unit, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy.

出版信息

J Surg Oncol. 2010 Jul 1;102(1):82-6. doi: 10.1002/jso.21541.

Abstract

BACKGROUND AND OBJECTIVES

Laparoscopy is gaining acceptance as a safe procedure for resection of liver neoplasms. The aim of this study is to evaluate surgical results and mid-term survival of minor hepatic resection performed for HCC.

METHODS

Data of 16 patients with HCC, undergoing laparoscopic hepatectomy from September 2005 to January 2009, were compared to a control group of 16 patients who underwent open resection (OR) during the same period. The two groups were matched in terms of type of resection, tumor size, and severity of cirrhosis.

RESULTS

One patient underwent conversion to an open approach. Laparoscopic approach resulted in shorter operating time (150 min, P:0.044) and lower blood loss (258 ml, P:0.008). There was no difference in perioperative morbidity and mortality rate; laparoscopic approach was associated with a shorter hospital stay (6.3 days, P:0.039). After a mean follow up of 32 months, disease free survival and overall survival were 40.2 and 23.3 months for laparoscopic group, and 47.7 and 31.4 months for OR group (P NS).

CONCLUSION

Laparoscopic resection of HCC is feasible and safe in selected patients and can result in good surgical results, with similar outcomes in terms of overall and disease-free survival.

摘要

背景与目的

腹腔镜技术在肝脏肿瘤切除术中的应用已得到广泛认可,且安全可行。本研究旨在评估腹腔镜肝切除术治疗小肝癌的手术效果和中期生存情况。

方法

选取 2005 年 9 月至 2009 年 1 月期间我院收治的 16 例 HCC 患者的临床资料进行回顾性分析,将其腹腔镜肝切除术(LH)结果与同期 16 例行开腹肝切除术(OR)患者的临床资料进行对比。两组患者在肿瘤大小、手术方式、肝硬化严重程度等方面匹配。

结果

1 例患者中转开腹。LH 组的手术时间(150min,P:0.044)和术中出血量(258ml,P:0.008)均明显低于 OR 组。两组围手术期并发症发生率和死亡率差异无统计学意义。LH 组患者术后住院时间明显短于 OR 组(6.3d,P:0.039)。术后平均随访 32 个月,LH 组和 OR 组的无瘤生存率和总生存率分别为 40.2%和 23.3%、47.7%和 31.4%,差异均无统计学意义(P NS)。

结论

腹腔镜肝切除术治疗小肝癌是安全可行的,且具有良好的手术效果,在总生存和无瘤生存方面与开腹手术相当。

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