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Clinical effect of laparoscopic versus open liver resection in treatment of patients with hepatocellular carcinoma complicated by liver cirrhosis
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摘要:
目的探讨肝硬化肝细胞癌患者行腹腔镜肝切除术与开腹肝切除术的临床疗效比较。方法收集2006年1月-2007年12月于临夏市人民医院确诊为肝硬化肝细胞癌的患者136例,分别行腹腔镜肝切除术（LLR组,64例）和开腹肝切除术（OLR组,72例）,分析2组患者的近期疗效、病理因素及远期疗效。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,生存函数的比较采用log-rank进行检验。结果与OLR组患者相比,LLR组在手术时间[（86.43±23.55）min vs（62.31±19.61）min]、术后住院时间[（7.22±3.45）d vs（12.27±5.31）d]方面差异有统计学意义（t值分别为8.539、2.764,P值分别为<0.001、0.024）,而在患者术中出血量、肝门阻断时间、总病死率方面差异均无统计学意义（p值均>0.05）。2组患者的肿瘤数目、有无肝硬化、有无微血管侵犯、有无肝包膜侵犯、切缘范围、最大肿瘤直径等差异亦无统计学意义（P值均>0.05）。远期疗效方面LLR组患者1、3、5年无疾病生存率分别为83.30%、48.61%、38.29%,O...
Abstract:Objective To investigate the clinical effect of laparoscopic liver resection( LLR) versus open liver resection( OLR) in the treatment of patients with hepatocellular carcinoma( HCC) complicated by liver cirrhosis. Methods A total of 136 patients who were diagnosed with HCC complicated by liver cirrhosis in Linxia Municipal People's Hospital from January 2006 to December 2007 were enrolled and underwent LLR( LLR group,64 patients) or OLR( OLR group,72 patients). The short-term outcome,pathological factors,and long-term outcome were compared between the two groups. The t-test was used for comparison of continuous data between groups,the chi-square test was used for comparison of categorical data between groups,and the log-rank test was used for comparison of survival functions.Results There were significant differences between the LLR group and the OLR group in time of operation(( 86. 43 ± 23. 55) min vs( 62. 31 ± 19. 61) min,t = 8. 539,P < 0. 001) and length of postoperative hospital stay(( 7. 22 ± 3. 45) d vs( 12. 27 ± 5. 31) d,t =2. 764,P = 0. 024),while there were no significant differences in intraoperative blood loss,time of hepatic portal occlusion,and overall fatality rate( all P > 0. 05). There were also no significant differences in number of tumors,presence or absence of liver cirrhosis,microvascular invasion,resection margin,and maximum tumor diameter between the two groups( all P > 0. 05). As for long-term outcome,the 1-,3-,and 5-year disease-free survival rates were 83. 30%,48. 61%,and 38. 29% in the LLR group and 78. 64%,51. 26%,and43. 01% in the OLR group; the 1-,3-,and 5-year overall survival rates were 97. 42%,95. 13%,and 89. 23% in the LLR group and96. 41%,94. 28%,and 90. 06% in the OLR group. There were no significant differences in these survival rates between the two groups( all P > 0. 05). Conclusion In patients with HCC complicated by liver cirrhosis,LLR helps to achieve rapid postoperative recovery and similar long-term outcome compared with OLR; therefore,it holds promise for clinical application.
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Key words:
- carcinoma /
- hepatocellular /
- liver cirrhosis /
- laparoscopes /
- hepatectomy /
- therapy
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[1]WAKABAYASHI G,KANEKO H.Can major laparoscopic liver and pancreas surgery become standard practices?[J].J Hepatobiliary Pancreat Sci,2016,23(2):89-91. [2]UNENBAT G,GHINBUREN J,TSIIREGZEN.Surgical outcome of laparoscopic liver resection in developing country[J].HPB,2016,18:e251. [3]KAWAGUCHI Y,HASEGAWA K,WAKABAYASHI G,et al.Survey results on daily practice in open and laparoscopic liver resections from 27 centers participating in the second International Consensus Conference[J].J Hepatobiliary Pancreat Sci,2016,23(5):283-288. [4]MORISE Z,CIRIA R,CHERQUI D,et al.Can we expand the indications for laparoscopic liver resection?A systematic review and meta-analysis of laparoscopic liver resection for patients with hepatocellular carcinoma and chronic liver disease[J].J Hepatobiliary Pancreat Sci,2015,22(5):342-352. [5]MIRNEZAMI R,MIRNEZAMI AH,CHANDRAKUMARANK,et al.Short-and long-term outcomes after laparoscopic and open hepatic resection:systematic review and meta-analysis[J].HPB(Oxford),2011,13(5):295-308. [6]ZHOU Y,XIAO Y,WU L,et al.Laparoscopic liver resection as a safe and efficacious alternative to open resection for colorectal liver metastasis:a meta-analysis[J].BMC Surg,2013,13:44. [7]LEI QC,WANG XY,ZHENG HZ,et al.Meta-analysis on safety and efficacy of application of fast-track surgery in laparoscopic hepatectomy[J].Chin J Gen Surg,2014,23(7):946-952.(in Chinese)雷秋成,王新颖,郑华珍,等.加速康复外科在腹腔镜肝切除术应用安全性与有效性的Meta分析[J].中国普通外科杂志,2014,23(7):946-952. [8]ZHOU YM,SHAO WY,ZHAO YF,et al.Meta-analysis of laparoscopic versus open resection for hepatocellular carcinoma[J].Dig Dis Sci,2011,56(7):1937-1943. [9]TWAIJI A,PUCHER PH,SODERGREN MH,et al.Laparoscopic vs open approach to resection of hepatocellular carcinoma in patients with known cirrhosis:systematic review and meta-analysis[J].World J Gastroenterol,2014,20(25):8274-8281. [10]YAMASHITA Y,IKEDA T,KURIHARA T,et al.Long-term favorable surgical results of laparoscopic hepatic resection for hepatocellular carcinoma in patients with cirrhosis:a single-center experience over a 10-year period[J].J Am Coll Surg,2014,219(6):1117-1123. [11]ZHANG GN,LI B.Updates of bleedimg control during laparoscopic hepatectomy[J].Chin J Pig Surg,2016,15(5):523-526.(in Chinese)张光年,李波.腹腔镜肝切除术中出血控制的研究进展[J].中华消化外科杂志,2016,15(5):523-526. [12]TRANCHART H,di GIURO G,LAINAS P,et al.Laparoscopic resection for hepatocellular carcinoma:a matched-pair comparative study[J].Surg Endosc,2010,24(5):1170-1176. [13]POON RT,FAN ST,NG IO,et al.Significance of resection margin in hepatectomy for hepatocellular carcinoma:a critical reappraisal[J].Ann Surg,2000,231(4):544-551. [14]BUELL JF,CHERQUI D,GELLER DA,et al.The international position on laparoscopic liver surgery:the Louisville Statement,2008[J].Ann Surg,2009,250(5):825-830. [15]TRUANT S,BOURAS AF,HEBBAR M,et al.Laparoscopic resection vs.open liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease:a case-matched study[J].Surg Endosc,2011,25(11):3668-3677. [16]BUUNEN M,GHOLGHESAEI M,VELDKAMP R,et al.Stress response to laparoscopic surgery:a review[J].Surg Endosc,2004,18(7):1022-1028. -
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