喻凯　庄波　龚道军　厉学民　罗建生　吴晓康　俞世安

[摘要] 目的 探討腹腔镜肝切除术与开腹肝切除术治疗肝细胞性肝癌的疗效差异。 方法 选取2015年11月至2017年6月在我院接受手术治疗的肝细胞性肝癌患者152例的资料进行回顾性分析，根据手术方法将其分为对照组（n=76）及试验组（n=76）。对照组采用开腹肝切除术，试验组采用腹腔镜肝切除术。比较两组的围术期相关指标、术前、术后1 d的肝功能、炎症指标变化情况、术后并发症发生情况、未复发生存时间及总生存时间。 结果 试验组的手术时间、失血量、切口长度、术后下床时间、术后进食时间、住院时间均短于对照组，差异有统计学意义（P<0.05）。术后1 d两组患者的谷丙转氨酶（ALT）、谷草转氨酶（AST）、白细胞计数（WBC）、降钙素原（PCT）均升高，术后1 d试验组患者的ALT、AST、WBC、PCT均低于对照组，差异有统计学意义（P<0.05）。试验组术后并发症总发生率低于对照组，差异有统计学意义（P<0.05）。试验组未复发生存时间和总生存时间均长于对照组，差异有统计学意义（P<0.05）。 结论 利用腹腔镜肝切除术治疗肝细胞性肝癌，患者术后恢复速度快，安全性良好，有助于提升其生存时间，改善远期预后。

[关键词] 腹腔镜;开腹肝切除术;肝细胞性肝癌;临床疗效

[中图分类号] R735.7          [文献标识码] B          [文章编号] 1673-9701（2021）06-0060-04

The clinical efficacies of laparoscopic and open hepatectomy in the treatment of hepatocellular liver cancer

YU Kai   ZHUANG Bo   GONG Daojun   LI Xuemin   LUO Jiansheng   WU Xiaokang   YU Shi′an

Department of Hepatobiliary Pancreaticogastroenterology Surgery， Affiliated Jinhua Hospital， Zhejiang University School of Medicine， Jinhua   321000， China

[Abstract] Objective To investigate the difference of therapeutic efficacies between laparoscopic and open hepatectomy in the treatment of hepatocellular liver cancer. Methods The data of 152 patients with hepatocellular liver cancer undergoing surgical treatment admitted to our hospital from November 2015 to June 2017 were analyzed retrospectively. All patients were divided into the control group（n=76） and the experimental group（n=76） according to the surgical methods. The control group was treated with open hepatectomy， while the experimental group was treated with laparoscopic hepatectomy. The perioperative related indexes， the changes of hepatic function and inflammatory indexes at baseline and 1 day after operation， postoperative complications， relapse-free survival time and total survival time were compared between the two groups. Results The operation duration， hemorrhage volume， incision length， postoperative off-bed activity time， postoperative feeding time and hospitalization time in the experimental group were all statistically significantly shorter than those in the control group（P<0.05）. On the 1st day after operation， the levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， white blood cell count （WBC） and procalcitonin （PCT） were increased in both groups. The levels of ALT， AST， WBC and PCT in the experimental group were statistically significantly lower than those in the control group on the first day after operation（P<0.05）. The total incidence of postoperative complications in the control group was statistically significantly higher than that in the experimental group（P<0.05）. The relapse-free survival time and overall survival time of the experimental group were statistically significantly longer than those of the control group（P<0.05）. Conclusion Laparoscopic hepatectomy on hepatocellular liver cancer has the advantages of rapid recovery and high safety， which is helpful to prolong the survival time and improve the long-term prognosis.

[Key words] Laparoscopy; Open hepatectomy; Hepatocellular liver cancer; Clinical efficacy

原发性肝癌的发病率在我国及全球范围内均呈缓慢增长趋势，有关的研究结果显示，原发性肝癌的死亡人数在全球癌症相关死亡人数中排名高居第三[1-3]。肝细胞性肝癌是原发性肝癌中占比最高的亚型，其构成比超过90%，且肝细胞性肝癌的恶性程度高、治疗困难、患者预后较差，对患者的健康和寿命影响很大[4-5]。对于确诊为肝细胞性肝癌的患者，一般采取以手术治疗为主的多种措施综合干预策略，其中手术对肝脏病灶的切除在整体治疗过程中扮演了极为重要的角色[6-7]。虽然手术对于任何患者均为创伤性操作，但是从长期结果而言，接受手术使患者获益更多。使用传统开腹操作方法完成切除，其创伤程度高，患者术后恢复困难[8]。……