赵一鸣+刘泽阳+潘奇+王龙蓉+张宁+周嘉敏+朱卫平+毛岸荣+林镇海+贺西淦+王益林+王鲁

摘要：目的 比较腹腔镜和开腹肝切除术在具有伴发疾病的老年肝脏恶性肿瘤患者中的疗效和短期获益。方法 纳入自2015年4—10月期间因肝脏恶性肿瘤接受肝切除的70岁及以上患者。17例腹腔镜手术患者的围手术期结果按照1：2的比例与传统开腹手术患者相匹配。结果 两组患者的年龄、性别、合并症发病率、乙型肝炎阳性率，肝功能Child评分无统计学差异。两组中位肿瘤大小均为3 cm。两组之间肝切除类型相似，手术时间无明显差异（腹腔镜195 min vs.开腹210 min，P = 0.436）。腹腔镜组围手术期失血量为150 mL，开腹组为330 mL，差异无统计学意义（P = 0.046）。腹腔镜组平均住院时间为6 d（3～15 d），开腹组为8 d（5～105 d）（P = 0.005）。结论 腹腔镜肝切除术对老年患者是安全可行的。腹腔镜手术的短期获益在老年患者肝脏肿瘤手术中仍然显见。

关键词：腹腔镜切除术；开腹切除术；肝脏恶性肿瘤；疗效

中图分类号：R657.3 文献标志码：A

Laparoscopic versus open liver resection for elderly patients with malignant liver tumors

ZHAO Yi-ming， LIU Ze-yang， PAN Qi， WANG Long-rong， ZHANG Ning， ZHOU Jia-min， ZHU Wei-ping， MAO An-rong， LIN Zhen-hai， HE Xi-gan， WANG Yi-lin， WANG Lu

Department of Liver Surgery ， Fudan University Cancer Center， Shanghai 200032，China

Abstract：Objective To compare the curative effect and short-term benefits of laparoscopic liver resection with open liver resection in elderly patients with malignant liver tumors and medical comorbidities. Methods Patients aged 70 and over who received liver resections for malignant liver tumors between January and October 2015 were enrolled. The perioperative outcomes of 17 patients with laparoscopic approach were matched and compared with those of 34 patients with conventional open approach in a 1：2 ratio. Results There was no significant difference found between the two groups with regard to age， gender， incidence of comorbid illness， hepatitis B positivity， and Child-Pugh grading of liver function. The median tumor size was 3 cm for both groups. The types of liver resection were similar between the two groups with no significant difference in the duration of operation （laparoscopic： 195 min vs. open： 210 min， P = 0.436）. The perioperative blood loss was 150 mL in the laparoscopic group and 330 mL in the open group （P = 0.046） with no significant difference in the number of patients with blood transfusion. The duration of hospital stay was 6 days （3–15 days） for the laparoscopic group and 8 days （5–105 days） for the open group （P = 0.005）. Conclusion Laparoscopic liver resection is safe and feasible for elderly patients. The short-term benefits of laparoscopic approach proves to be evident for geriatric oncological liver surgery.

Keywords： laparoscopic liver resection； open liver resection； malignant liver tumors； curative effect

由于大多數发达国家人口老龄化，老年恶性肿瘤患者的治疗已成为全球性问题。肝恶性肿瘤如肝细胞癌和结肠直肠肝转移是最常见的恶性肿瘤之一，在老年患者中这些肿瘤的发病率更高。以前的研究表明，开腹肝切除术对于具有可接受的低术后发病率和良好的长期肿瘤学结果的老年患者是可行的[1-4]。另一方面，肝切除术可以在腹腔镜下进行的可行性问题近年来引起了广泛的关注。许多研究表明，与开腹方法相比，腹腔镜肝切除术可以在手术并发症发生率和住院时间方面得到更好的围手术期结果[5-7]。……