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) : 581 -584. doi: 10.3877/cma.j.issn.1674-3946.2020.06.014

所属专题: 文献

论著

腹腔镜解剖性肝切除术与非解剖性肝切除术的前瞻性对比研究
赵学勤1, 朴纪颖1,(), 张秉武1, 康晓丽1   
  1. 1. 067000 中国人民解放军联勤保障部队第981医院
  • 收稿日期:2019-09-09 出版日期:2020-12-26
  • 通信作者: 朴纪颖

A prospective comparison study between laparoscopic anatomic and non-anatomic hepatectomy

Xueqin Zhao1, Jiying Pu1,(), Bingwu Zhang1, Xiaoli Kang1   

  1. 1. The 981 hospital of the joint logistic support force of the PLA 067000
  • Received:2019-09-09 Published:2020-12-26
  • Corresponding author: Jiying Pu
  • About author:
    Ccorresponding author: Pu Jiying, Email:
  • Supported by:
    Project of Chengde Science and Technology Bureau Research and Development Program(201706A066)
引用本文:

赵学勤, 朴纪颖, 张秉武, 康晓丽. 腹腔镜解剖性肝切除术与非解剖性肝切除术的前瞻性对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2020, 14(06): 581-584.

Xueqin Zhao, Jiying Pu, Bingwu Zhang, Xiaoli Kang. A prospective comparison study between laparoscopic anatomic and non-anatomic hepatectomy[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(06): 581-584.

目的

探讨腹腔镜下解剖性肝切除术和非解剖性肝切除术治疗肝癌的临床疗效。

方法

按照前瞻性随机对照试验选取本院2015年1月至2018年2月期间收治的106例肝癌患者进行,按照随机数字表法分为解剖组(行腹腔镜解剖性肝切除术)和非解剖组(行腹腔镜非解剖性肝切除术)各53例。采用SPSS20.0统计软件对数据进行分析,围术期指标、肝功能指标用(±s)表示,采用独立t检验;术后并发症发生率、术后1年复发转移率和生存率组间比较用χ2检验;P<0.05为差异有统计学意义。

结果

解剖组的手术时间明显长于非解剖组,但术中出血量、输血量明显减少,住院时间显著短于非解剖组(P<0.05)。非解剖组术后第1、3、7天血清ALT、TBIL值明显高于解剖组(P<0.05);术后1、3天血清AST值解剖组低于非解剖组(P<0.05)。解剖组术后并发症发生率为7.5%低于非解剖组22.6%(P<0.05)。解剖组与非解剖组1年总体生存率分别为94.3%和88.6%,两组差异无统计学意义(P>0.05);1年无瘤生存率分别为90.6%和75.5%(P=0.038),两组差异有统计学意义(P<0.05)。

结论

相对于腹腔镜非解剖性肝切除术,腹腔镜解剖性肝切除术临床疗效更好,并有效提高1年无瘤生存率,值得在临床上进一步推广应用。

Objective

To investigate the clinical efficacy of laparoscopic anatomical and non-anatomical hepatectomy for liver cancer.

Methods

According to the prospective randomized controlled trial, 106 patients with hepatocellular carcinoma admitted to our hospital from January 2015 to February 2018 were divided into the anatomical group (laparoscopic anatomical hepatectomy) and the non-anatomical group (laparoscopic non-anatomical hepatectomy) according to the random number table method, 53 cases in each group. Statistical analysis were performed by using SPSS20.0 software. Measurement data, such as Perioperative indicators and liver function indicators were expressed as (±s), and were examined by using independent t test. The incidence of complications, recurrence and metastasis rate and 1-year survival rate were analyzed by using 2 test. A P value <0.05 was considered as statistically significant difference.

Results

The operation time in the anatomical group was much longer than that in the non-anatomical group, however the amount of bleeding and blood transfusion during the operation was significantly less and the hospital stay was significantly shorter than that in the non-anatomical group (P<0.05). The serum ALT and TBIL values in non-anatomical group were significantly higher than those in anatomical group on the POD 1, 3 and 7 (P<0.05), and the serum AST values in anatomical group were significantly lower than those in non-anatomical group on the POD 1 and 3 respectively (P<0.05). The incidence of postoperative complications was 7.5% in the anatomical group and 22.6% in the non-anatomical group. The overall incidence of postoperative complications in the anatomical group was lower than that in the non-anatomical group (P<0.05). The 1-year overall survival rates in the anatomical group and the non-anatomical group were 94.3% and 88.6% respectively, with no significant difference between the two groups (P>0.05); The 1-year tumor-free survival rates were 90.6% and 75.5% (P=0.038), respectively, wtih significant difference between the two groups (P<0.05).

Conclusion

Compared with laparoscopic non-anatomical hepatectomy, laparoscopic anatomical hepatectomy has better clinical effect and could effectively improve one-year disease-free survival rate, which is worthy of further clinical application.

表1 106例肝癌患者不同术式两组患者一般资料比较[(±s), n]
表2 106例肝癌患者不同术式两组患者围术期指标比较(±s)
表3 106例肝癌患者不同术式两组患者术后并发症发生情况(例)
表4 106例肝癌患者不同术式两组患者肝功能指标比较(±s)
图1 106例肝癌患者不同术式术后1年两组患者总生存率和无瘤生存率
[1]
文天夫.原发性肝癌诊疗规范(2017年版)解读[J].中国普外基础与临床杂志,2018, 25(1): 32-34.
[2]
章家超,孙早喜,赵中辛. 肝细胞癌解剖性肝切除进展[J]. 腹部外科,2018, 31(1): 68-72.
[3]
戴朝六,徐锋,金添强.腹腔镜肝切除:解剖性与非解剖性利弊之我见[J/CD].中华普外科手术学杂志(电子版),2019, 13(3): 228-231.
[4]
Moris D, Tsilimigras DI, Kostakis ID,et al.Anatomic versus Non-anatomic Resection for Hepatocellular Carcinoma: A Systematic Review and Meta-analysis[J]. European Journal of Surgical Oncology, 2018, 44(7): 927-938.
[5]
沈学艺,陈德烽,陈宇峰,等.腹腔镜解剖性半肝切除治疗肝癌的远期临床疗效观察[J].中国现代医生,2018, 56(24): 47-50.
[6]
赵云,张光亚,别玉坤,等.腹腔镜非解剖性肝切除术治疗原发性肝癌的临床疗效分析[J].腹部外科,2019, 32(1): 35-39.
[7]
Huang X, Lu S. A Meta-analysis comparing the effect of anatomi-cal resection vs. non-anatomical resection on the long-term out-comes for patients undergoing hepatic resection for hepatocellular carcinoma [J]. HPB ( Oxford),2017, 19(10): 843-849.
[8]
张立献,张伟,王国珍,等. 腹腔镜下不同肝切除方式治疗原发性肝癌的临床疗效分析[J].肝胆外科杂志,2018, 26(2): 119-122.
[9]
李杰原,陈焕伟,王锋杰,等.腹腔镜下解剖性与非解剖性肝切除术在早期原发性肝癌中的临床疗效对比[J].现代医用影像学,2019, 28(7): 1685-1687.
[10]
Kaibori M, Kon M, Kitawaki T, et al. Comparison of anatomicand non-anatomic hepatic resection for hepatocellular carcinoma[J]. J Hepatobiliary Pancreat Sci, 2017, 24(11): 616-626.
[11]
翟志超,任为正,刘志伟,等. 解剖性与非解剖性肝切除治疗原发性肝癌远期疗效的比较[J]. 中华肝胆外科杂志,2017, 23(11): 771-775.
[12]
Kang KJ, Ahn KS. Anatomical resection of hepatocellular carcinoma: A critical review of the procedure and its benefits on survival[J]. World J Gastroenterol, 2017, 23(7): 1139-1146.
[13]
李国松.解剖性肝切除术对原发性肝癌的治疗效果及安全性分析[J].中国医药指南,2019, 17(14): 218-219.
[14]
戴朝六,徐锋,金添强.腹腔镜解剖性肝切除的利与弊[J/CD].中华普外科手术学杂志(电子版),2018, 12(5): 364-367.
[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] 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.
[11] 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.
[12] 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.
[13] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143.
[14] 李凯, 陈淋, 苏怀东, 向涵, 张伟. 超微创器械在改良单孔腹腔镜巨大肝囊肿开窗引流及胆囊切除中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 144-144.
[15] 魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145.
阅读次数
全文


摘要