Inoue Yoshihiro, Yokohama Keisuke, Ohama Hideko, Tsuchimoto Yusuke, Terazawa Tetsuji, Asai Akira, Fukunishi Shinya, Okuda Junji, Higuchi Kazuhide, Uchiyama Kazuhisa
Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan.
Second Department of Internal Medicine, Osaka Medical College Hospital, Osaka, Japan.
Prz Gastroenterol. 2020;15(3):225-233. doi: 10.5114/pg.2020.99039. Epub 2020 Sep 19.
Laparoscopic hepatectomy (LH) is very difficult to perform in patients with cirrhosis because of the haemorrhagic and fibrotic nature of the liver, although there are various advantages to laparoscopic surgery.
To investigate the surgical outcomes, and efficacy and safety of LH versus open hepatectomy (OH) for hepatocellular carcinoma (HCC) resection.
A total of 112 patients with cirrhosis, who underwent hepatectomy, were analysed retrospectively. We investigated the safety and efficacy of LH for HCC with cirrhosis. Student's and χ tests, Mann-Whitney's test, Wilcoxon's signed-rank test, and Fisher's exact test were used in the statistical analysis.
Seventy-one patients underwent LH, and 41 underwent OH. The conversion rate from LH to OH was 12.7%. After propensity score matching, the estimated blood loss was significantly lower in the LH group than in the OH group (25 vs. 310 ml; < 0.001), and there was a significant difference between the groups in the operative time ( = 0.091). The LH group had complication rates of 3.6% and 0% for refractory ascites and pleural effusion, respectively, while those were 17.9% and 10.7%, respectively, in the OH group ( = 0.019 and = 0.005, respectively). The LH group had no mortality, whereas the OH group had a mortality rate of 10.7% ( = 0.038). The postoperative length of stay was significantly longer in the LH group than in the OH group (9 days vs. 14 days) ( = 0.002).
LH can be performed safely for HCC with cirrhosis. More favourable results are achieved with LH than with OH in terms of surgical outcomes.
尽管腹腔镜手术有诸多优势，但由于肝硬化患者肝脏具有出血和纤维化的特性，腹腔镜肝切除术（LH）在这类患者中实施难度很大。
探讨腹腔镜肝切除术（LH）与开腹肝切除术（OH）治疗肝细胞癌（HCC）切除的手术效果、疗效及安全性。
对112例行肝切除术的肝硬化患者进行回顾性分析。我们研究了LH治疗肝硬化合并HCC的安全性和疗效。统计分析采用学生t检验、χ²检验、曼-惠特尼U检验、威尔科克森符号秩检验和费舍尔精确检验。
71例患者接受了LH，41例接受了OH。LH转为OH的转化率为12.7%。倾向评分匹配后，LH组估计失血量显著低于OH组（25 vs. 310 ml；P<0.001），两组手术时间存在显著差异（P = 0.091）。LH组难治性腹水和胸腔积液的并发症发生率分别为3.6%和0%，而OH组分别为17.9%和10.7%（P分别为0.019和0.005）。LH组无死亡病例，而OH组死亡率为10.7%（P = 0.038）。LH组术后住院时间显著长于OH组（9天 vs. 14天）（P = 0.002）。
对于肝硬化合并HCC患者，LH可安全实施。在手术效果方面，LH比OH取得了更有利的结果。
