Chen Junhua, Li Hongyu, Liu Fei, Li Bo, Wei Yonggang
Department of Hepatic Surgery Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Medicine (Baltimore). 2017 Mar;96(12):e6460. doi: 10.1097/MD.0000000000006460.
Although the number of laparoscopic liver resections (LRRs) has increased, studies of surgical outcomes in comparison with the conventional open approach are limited. The purpose of this study was to analyze the surgical outcomes (safety and efficacy) of LLR versus open liver resection (OLR) for hepatocellular carcinoma (HCC).We collected data on all patients who received liver resection for HCC between April 2015 and September 2016 in our institution, and retrospectively investigated the demographic and perioperative data, and also surgical outcomes.Laparoscopic liver resection was performed in 225 patients and OLR in 291. In patients who underwent minor hepatectomy, LLR associated with a shorter duration of operation time (200 vs 220 minutes; P < 0.001), less blood loss (100 vs 225 mL; P < 0.001), lower transfusion rate (3.0% vs 12.0%; P = 0.012), and shorter postoperative hospital stay (6 vs 7 days; P < 0.001) compared with OLR. Dietary recovery was relatively fast in the group of LLR, but there were no significant differences in hepatic inflow occlusion rate, complication rate, and transfusion volume. Patients who received major hepatectomy had a longer duration of operation (240 vs 230 minutes; P < 0.001), less blood loss (200 vs 400 mL; P < 0.001), lower transfusion rate (4.8% vs 16.5%; P = 0.002), lower hepatic inflow occlusion rate (68.3% vs 91.7%; P < 0.001), and shorter postoperative hospital stay (6 vs 8 days; P < 0.001). Complication rate (P = 0.366) and transfusion volume (P = 0.308) did not differ between groups.Laparoscopic liver resection is a feasible and safe alternative to OLR for HCC when performed by a surgeon experienced with the relevant surgical techniques, associated with less blood loss, lower transfusion rate, a rapid return to a normal diet, and shorter postoperative hospital stay with no compromise in complications. Further, long-term follow-up should be acquired for adequate evaluation for survival.
尽管腹腔镜肝切除术（LRR）的数量有所增加，但与传统开放手术方式相比，关于手术效果的研究仍然有限。本研究旨在分析腹腔镜肝切除术（LLR）与开放性肝切除术（OLR）治疗肝细胞癌（HCC）的手术效果（安全性和有效性）。我们收集了2015年4月至2016年9月在我院接受肝癌肝切除术的所有患者的数据，并回顾性调查了人口统计学和围手术期数据以及手术效果。225例患者接受了腹腔镜肝切除术，291例接受了开放性肝切除术。在接受小范围肝切除术的患者中，与开放性肝切除术相比，腹腔镜肝切除术的手术时间更短（200分钟对220分钟；P<0.001），失血量更少（100毫升对225毫升；P<0.001），输血率更低（3.0%对12.0%；P=0.012），术后住院时间更短（6天对7天；P<0.001）。腹腔镜肝切除组的饮食恢复相对较快，但在肝血流阻断率、并发症发生率和输血量方面无显著差异。接受大范围肝切除术的患者手术时间较长（240分钟对230分钟；P<0.001），失血量较少（200毫升对400毫升；P<0.001），输血率较低（4.8%对16.5%；P=0.002），肝血流阻断率较低（68.3%对9
