切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 569 -572. doi: 10.3877/cma.j.issn.1674-3946.2020.06.011

所属专题: 文献

论著

多措施联合的腹腔镜肝切除术治疗肝癌合并肝硬化并门静脉高压症的临床应用研究
贾守洪1, 鲁旭1,(), 彭彬1   
  1. 1. 638000 四川广安,四川大学华西广安医院(广安市人民医院)
  • 收稿日期:2019-10-31 出版日期:2020-12-26
  • 通信作者: 鲁旭

Clinical application of multiple measures combined with laparoscopic liver resection for patients with hepatocellular carcinoma complicated with cirrhosis and portal hypertension

Shouhong Jia1, Xu Lu1,(), Bin Peng1   

  1. 1. Sichuan University Huaxi Guangan Hospital (Guang'an people's Hospital), Sichuan 638000, China
  • Received:2019-10-31 Published:2020-12-26
  • Corresponding author: Xu Lu
  • About author:
    Corresponding author: Lu Xu, Email:
  • Supported by:
    Sichuan Provincial Natural Science Foundation(wj20170526)
引用本文:

贾守洪, 鲁旭, 彭彬. 多措施联合的腹腔镜肝切除术治疗肝癌合并肝硬化并门静脉高压症的临床应用研究[J/OL]. 中华普外科手术学杂志(电子版), 2020, 14(06): 569-572.

Shouhong Jia, Xu Lu, Bin Peng. Clinical application of multiple measures combined with laparoscopic liver resection for patients with hepatocellular carcinoma complicated with cirrhosis and portal hypertension[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(06): 569-572.

目的

探讨多措施联合的腹腔镜肝切除术(LLR)治疗肝癌合并肝硬化并门静脉高压症的临床效果。

方法

回顾性分析2015年1月至2017年7月经LLR治疗43例肝癌合并肝硬化并门静脉高压症患者资料,其中联合组(n=23)给予多措施联合的LLR,常规组(n=20)给予常规LLR。患者随访情况统计到2019年7月。选用SPSS 22.00统计软件进行数据分析。围术期指标用(±s)表示,采用独立t检验;并发症发生情况采用χ2Fisher检验。P<0.05差异有统计学意义。

结果

联合组手术时间、术中出血量、输血量、胃肠减压时间和住院时间显著低于常规组(P<0.05),43例患者中,术后1周内共发生9例并发症,无肝功能衰竭情况发生,联合组术后并发症发生率20.9%(3/23)低于常规组30%(6/20),但两组比较差异无统计学意义(P>0.05)。联合组截止至观察终点复发转移率为46.5%(11/23)小于常规组61.2%(12/20),两组患者截止至观察终点无病生存率比较差异无统计学意义(χ2=0.637,P=0.425)。

结论

多措施联合的LLR治疗肝癌合并肝硬化并门静脉高压症安全可行,术中出血少、手术时间短、并发症少、术后复发率较低。

Objective

To explore the clinical effect of multiple measures combined with laparoscopic liver resection for patients with hepatocellular carcinoma complicated with cirrhosis and portal hypertension.

Methods

The clinical data of 43 patients with liver cancer complicated with cirrhosis and portal hypertension, who received laparoscopic hepatectomy from January 2015 to July 2017, were retrospectively analyzed. Patients in the combined group (n=23) was given multiple measures combined laparoscopic hepatectomy, while patients in the conventional group (n=20) was given conventional laparoscopic hepatectomy. The postoperative follow-up of the patients ended up on July 2019. Statistical analysis were performed by using SPSS 22.0 software. Measurement data, such as Perioperative indicators were expressed as (±s), and were examined by using independent t test. postoperative complications were analyzed by using χ2 test A P value < 0.05 was considered as statistically significant difference.

Results

The operation time, intraoperative blood loss, transfusion volume, gastrointestinal decompression time and hospital stay in the combined group were significantly lower than those in the conventional group respectively (P<0.05); Among 43 patients, 9 complications occurred within one week after surgery, and no liver failure occurred. The postoperative complication rate was 20.9% (3/23) in the multi-treatment group, which was lower than 30% (6/20) in the conventional group, with no significant difference (P>0.05). The recurrence and metastasis rate of the multi-method combination group was 46.5% (11/23), which was lower than 61.2% (12/20) in the conventional group. There was no significant difference in the disease-free survival rate between two groups until the observation end point (χ2=0.637, P=0.425).

Conclusion

Multi-measurement combined with laparoscopic liver resection for the treatment of liver cancer with cirrhosis and portal hypertension is safe and feasible, with less intraoperative bleeding, shorter operation time, less complications, and lower postoperative recurrence rate.

表1 43例HCC合并肝硬化并门静脉高压症患者不同术式两组一般资料比较[(±s),例]
表2 43例HCC合并肝硬化并门静脉高压症患者不同术式两组患者围术期指标比较(±s)
表3 43例HCC合并肝硬化并门静脉高压症患者不同术式两组术后并发症发生情况比较(例)
图1 43例HCC合并肝硬化并门静脉高压症患者不同术式两组患者截止至观察终点无病生存曲线比较
[1]
Forner A, Reig M, Bruix J.Hepatocellular carcinoma[J].Lancet,2018, 391(10127): 1301-1314.
[2]
Siegel RL, Miller KD, Jemal A.Cancer statistics,2018[J].CA Cancer J Clin,2018, 68(1): 7-30.
[3]
Berzigotti A, Reig M, Abraldes JG,et al. Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis: a systematic review an meta-analysis[J]. Hepatology,2015, 61(2): 526-536.
[4]
中华人民共和国国家卫生和计划生育委员会.原发性肝癌诊疗规范(2017版)[J].临床肝胆病杂志,2017, 33(8): 1419-1431.
[5]
Yang T, Lau WY, Zhang H,et al.Should surgery be carried out in patients with hepatocellular carcinoma with portal hypertension?[J].Hepatology, 2015, 62(3): 976.
[6]
Zhong JH, Li LQ.Portal hypertension should not be a contraindication of hepatic resection to treat hepatocellular carcinoma with compensated cirrhosis[J].Hepatology,2015, 62(3): 977-978.
[7]
Cucchetti A, Cescon M, Pinna AD. Portal hypertension and the outcome of surgery for hepatocellular carcinoma in compensated cirrhosis:a systematic review and meta-analysis. more doubts than clarity[J]. Hepatology,2015, 62(3): 976-977.
[8]
张松,潘树波,谢坤,等.精准肝脏外科理念在肝细胞肝癌治疗中的价值[J].安徽医科大学学报,2016, 51(1): 94-97.
[9]
Schoening WN, Denecke T, Neumann UP. [Preoperative imaging/operation planning for liver surgery][J].Chirurg,2015, 86(12): 1167-1179.
[10]
周雨,简志祥.术前肝储备功能评估与手术决策[J/CD].中华肝脏外科手术学电子杂志,2018, 7(5): 364-370.
[11]
周伟平,王志恒.三维可视化技术对肝脏肿瘤手术治疗的影响[J/CD].中华腔镜外科杂志(电子版),2018, 11(3) 134-137.
[12]
李仓,张启瑜,孙克龙,等.肝癌切除联合选择性减断流术在原发性肝癌合并中重度门静脉高压症中的应用[J].肝胆胰外科杂志,2015, 27(1): 5-8.
[13]
李梅生,甄作均.腹腔镜肝切除术主要并发症的预防和处理[J/CD].消化肿瘤杂志(电子版),2015, 7(4): 181-183.
[14]
殷子,卢昕,刘宇斌,等.腹腔镜下肝切除术后并发症相关危险因素分析[J/CD].消化肿瘤杂志(电子版),2015, 7(4): 204-208.
[15]
Choo SP, Tan WL, Goh BKP,et al.Comparison of hepatocellular carcinoma in Eastern versus Western populations[J].Cancer,2016, 122(22): 3430-3446.
[1] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[2] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[3] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[4] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[5] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[6] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[7] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[8] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[9] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[10] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[11] 李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[12] 韩戟, 杨力, 陈玉. 腹部形态CT参数与完全腹腔镜全胃切除术术中失血量的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 88-91.
[13] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[14] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[15] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
阅读次数
全文


摘要