中华肝胆外科杂志2024,Vol.30Issue(10) :733-737.DOI:10.3760/cma.j.cn113884-20240530-00164

基于三维重建下的腹腔镜与开腹肝切除术治疗中央部位肝细胞癌的疗效分析

Clinical analysis of laparoscopic versus open hepatectomy for hepatocellular carcinoma in the central region of liver based on three-dimensional image reconstruction

郭宇麒 郭亚欣 李世朋 王亚峰 唐昌乾 王文森 李德宇 王连才
中华肝胆外科杂志2024,Vol.30Issue(10) :733-737.DOI:10.3760/cma.j.cn113884-20240530-00164

基于三维重建下的腹腔镜与开腹肝切除术治疗中央部位肝细胞癌的疗效分析

Clinical analysis of laparoscopic versus open hepatectomy for hepatocellular carcinoma in the central region of liver based on three-dimensional image reconstruction

郭宇麒 1郭亚欣 2李世朋 1王亚峰 1唐昌乾 3王文森 1李德宇 1王连才1
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作者信息

  • 1. 郑州大学人民医院肝胆胰腺外科,郑州 450003
  • 2. 郑州大学人民医院放射科,郑州 450003
  • 3. 河南大学人民医院肝胆胰腺外科,郑州 450003
  • 折叠

摘要

目的 观察基于三维重建下的腹腔镜肝切除术与开腹肝切除术治疗中央部位肝细胞癌的疗效.方法 回顾性分析2020年1月至2023年12月郑州大学人民医院收治的118例中央部位肝细胞癌患者的临床资料,其中男性85例,女性33例,年龄(57.5±8.9)岁.根据手术方式,将患者分为两组:行开腹肝切除术的患者纳入开腹组(n=66);行腹腔镜下肝切除术的患者纳入腹腔镜组(n=52).所有患者术前均行三维重建,评估肿瘤位置.比较两组患者的手术时间、术中出血量、术后住院时间、并发症情况及预后.结果 与开腹组相比,腹腔镜组患者的年龄较小[(55±9)岁比(59±8)岁],手术时间增加[212.5(152.5,262.3)min 比 161.5(135.8,210.0)min],术后住院时间缩短[11.0(9.0,13.0)d比13.0(11.0,15.3)d],差异均具有统计学意义(均P<0.05).术后病理结果显示,两组患者均为R0切除.腹腔镜组和开腹组患者术后并发症发生率分别为34.6%(18/52)和39.4%(26/66),两组比较,差异无统计学意义(x2=0.28,P=0.594).开腹组患者术后1、3年的无复发生存率分别为69.7%、53.0%,腹腔镜组术后1、3年的无复发生存率分别为71.2%、53.8%,两组患者术后无复发生存率比较差异无统计学意义(P=0.953).结论 基于三维重建下的腹腔镜肝切除术与开腹肝切除术治疗中央部位肝细胞癌均安全可行,腹腔镜手术可以达到与传统开腹手术同样的临床预后,且术后住院时间更短.

Abstract

Objective To compare the therapeutic efficacy of laparoscopic versus open hepatectomy based on three-dimensional image reconstruction in the treatment of hepatocellular carcinoma(HCC)in the central region of liver.Methods Clinical data of 118 patients with HCC located in the central region of liver undergoing hepatectomy in the People's Hospital of Zhengzhou University from January 2020 to Decem-ber 2023 were retrospectively analyzed,including 85 males and 33 females,aged(57.5±8.9)years old.According to surgical approach,patients were divided into two groups:the open surgery group(n=66)and laparoscopic surgery group(n=52).All patients underwent three-dimensional image reconstruction preopera-tively to determine the tumor location and its relationship with the hepatic vessels.The operative duration,intraoperative blood loss,incidence of postoperative complications,postoperative hospital stay,and prognosis were compared between the groups.Results Compared to open surgery,patients in laparoscopic group were younger[(55±9)years old vs.(59±8)years old],and experienced a longer operative time[212.5(152.5,262.3)min vs.161.5(135.8,210.0)min]and a shorter postoperative hospital stay[11.0(9.0,13.0)d vs.13.0(11.0,15.3)d](all P<0.05).Postoperative pathology indicated that R0 resection was achieved in both groups.The incidence of postoperative complications were comparable between the two groups[34.6%(18/52)vs.39.4%(26/66),x2=0.28,P=0.594].The 1-year and 3-year recurrence-free survivals were 69.7%and 53.0%in laparoscopic group,similar to those in open group(71.2%and 53.8%,respetctively,P=0.953).Conclusion Laparoscopic hepatectomy based on three-dimensional image reconstruction is safe and feasible for HCC in central region in terms of clinical prognosis.Laparoscopic surgery is also associated with a shorter postoperative hospital stay.

关键词

癌,肝细胞/腹腔镜/肝切除术

Key words

Carcinoma,hepatocellular/Laparoscopes/Hepatectomy

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基金项目

河南省科技攻关计划(202102310126)

河南省科技研发计划联合基金(232301420056)

河南省中青年卫生健康科技创新优秀青年人才培养计划(YXKC2021048)

出版年

2024
中华肝胆外科杂志
中华医学会

中华肝胆外科杂志

CSTPCDCSCD北大核心
影响因子:1.846
ISSN:1007-8118
参考文献量18
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