You Nan, Wang Zheng, Wu Ke, Wang Liang, Li Jing, Zheng Lu
Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China.
Surg Endosc. 2023 Jan;37(1):358-363. doi: 10.1007/s00464-022-09491-5. Epub 2022 Aug 10.
Hepatocellular carcinoma (HCC) is a common malignancy of the digestive system with high morbidity and high mortality worldwide. Currently, surgical resection is considered the most effective treatment for HCC. Laparoscopic surgery is a major trend in contemporary minimally invasive surgery. However, is laparoscopic resection suitable for HCC patients with diaphragmatic involvement? If so, then what is the preferred resection method, and how safe and effective is this treatment? Are there any factors that require special attention?
Clinical data of 17 patients who underwent laparoscopic surgery in the Second Affiliated Hospital, Third Military Medical University (Army Medical University) from January 2018 to February 2021 were retrospectively analyzed.
The mean age was 48.9 ± 14.0 years; mean operation time, 186.00 ± 18.3 min; median blood loss, 170.0 ml (140.8-207.5 ml); and median length of hospital stay, 8.0 days (7.0-9.5 days). There was no case of open conversion. Pathologic findings revealed all cases of HCC. Intraoperative frozen pathology and postoperative pathology showed free surgical margins. Six patients had pathologically confirmed diaphragmatic invasion (DI), and eleven was confirmed as having diaphragmatic fibrous adhesion (DFA) only. Post-operative complications included liver section effusion, pleural effusion, pneumonia and bile leak. All the complications responded well to conservative treatment. No other abnormality was noted during outpatient follow-up examination. Sixteen patients survived tumor-free; one patient with HCC developed intrahepatic metastasis 1 year after surgery, and this patient survived with tumor after treatment.
Our experience initially provides valuable support for the laparoscopic surgical treatment of HCC patients with diaphragmatic involvement.
肝细胞癌（HCC）是消化系统常见的恶性肿瘤，在全球范围内发病率和死亡率都很高。目前，手术切除被认为是治疗HCC最有效的方法。腹腔镜手术是当代微创手术的主要趋势。然而，腹腔镜切除术是否适用于有膈肌受累的HCC患者？如果适用，那么首选的切除方法是什么，这种治疗的安全性和有效性如何？是否有任何需要特别关注的因素？
回顾性分析2018年1月至2021年2月在陆军军医大学第二附属医院接受腹腔镜手术的17例患者的临床资料。
平均年龄为48.9±14.0岁；平均手术时间为186.00±18.3分钟；中位失血量为170.0毫升（140.8 - 207.5毫升）；中位住院时间为8.0天（7.0 - 9.5天）。无中转开腹病例。病理检查结果显示均为HCC病例。术中冰冻病理及术后病理均显示手术切缘阴性。6例患者病理证实有膈肌侵犯（DI），11例仅证实有膈肌纤维粘连（DFA）。术后并发症包括肝断面积液、胸腔积液、肺炎和胆漏。所有并发症经保守治疗后恢复良好。门诊随访检查未发现其他异常。16例患者无瘤生存；1例HCC患者术后1年发生肝内转移，经治疗后带瘤生存。
我们的经验初步为腹腔镜手术治疗有膈肌受累的HCC患者提供了有价值的支持。
