| 黄俊海,黄 磊,陈 彬,庞润华,钟 崇.腹腔镜与开腹肝切除术治疗原发性肝细胞癌的疗效对比研究及术后2年复发的影响因素分析[J].,2022,(19):3684-3688 |
| 腹腔镜与开腹肝切除术治疗原发性肝细胞癌的疗效对比研究及术后2年复发的影响因素分析 |
| Comparative Study of Efficacy of Laparoscopic and Open Hepatectomy in the Treatment of Primary Hepatocellular Carcinoma and Analysis of the Influencing Factors of Recurrence 2 Years after Operation |
| 投稿时间：2022-04-06 修订日期：2022-04-28 |
| DOI：10.13241/j.cnki.pmb.2022.19.016 |
| 中文关键词: 腹腔镜 开腹 原发性肝细胞癌 疗效 复发 影响因素 |
| 英文关键词: Laparoscopic Open Primary hepatocellular carcinoma Efficacy Recurrence Influencing factors |
| 基金项目:广东省中医药局科研项目（20221157） |
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| 中文摘要: |
| 摘要 目的：对比腹腔镜与开腹肝切除术治疗原发性肝细胞癌（HCC）的疗效，并分析术后2年复发的影响因素。方法：回顾性分析2018年1月至2020年1月我院收治的108例HCC患者的病例资料，其中62例采用腹腔镜手术治疗（腹腔镜组），46例采用开腹手术治疗（开腹组），比较两组手术、术后恢复指标以及术后并发症差异。术后随访2年，根据是否复发分为复发组（45例）和未复发组（63例），收集临床资料，分析HCC术后复发的影响因素。结果：腹腔镜组术中出血量少于开腹组，切口长度、术后首次排气时间、术后首次下床活动时间、术后住院时间短于开腹组，切口渗液发生率低于开腹组，但手术时间长于开腹组，差异均有统计学意义（P＜0.05）。复发组肿瘤数目、肿瘤直径大于未复发组（P＜0.05），2型糖尿病、CNLC分期 Ⅱb～Ⅲa期、低中度肿瘤分化程度、门静脉癌栓、微血管侵犯、肝硬化、术前HBV-DNA载量＞104拷贝/mL、开腹手术的患者比例高于未复发组（P＜0.05）。合并2型糖尿病、门静脉癌栓、微血管侵犯、术前HBV-DNA载量＞104拷贝/mL是HCC术后复发的危险因素（P＜0.05）。结论：与开腹手术比较，腹腔镜手术可减少创伤，更有利于术后康复，并可降低围术期并发症和术后复发率。2型糖尿病、门静脉癌栓、微血管侵犯、术前HBV-DNA载量是HCC术后复发的影响因素。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the efficacy of laparoscopic and open hepatectomy in the treatment of primary hepatocellular carcinoma (HCC), and to analyze the influencing factors of recurrence 2 years after operation. Methods: The case data of 108 patients with HCC who were treated in our hospital from January 2018 to January 2020 were retrospectively analyzed, including 62 cases treated with laparoscopic surgery (laparoscopic group), and 46 cases treated with open surgery (open group). The differences of operation, postoperative recovery indexes and postoperative complications between the two groups were compared. The patients were followed up for 2 years. They were divided into recurrence group (45 cases) and non-recurrence group (63 cases) according to whether they had recurrence. The clinical data were collected, and the influencing factors of postoperative recurrence of HCC were analyzed. Results: The amount of intraoperative bleeding in the laparoscopic group was less than that in the open group, the length of incision, the first postoperative exhaust time, the first postoperative ambulation time and the postoperative hospital stay were shorter than those in the open group, and the incidence of incision exudation was lower than that in the open group, but the operation time was longer than that in the open group, the differences were statistically significant(P<0.05). The number of tumors and the diameter of tumor in recurrence group were larger than those in non-recurrence group(P<0.05). The type 2 diabetes mellitus, CNLC stage Ⅱb～Ⅲa stage, low and moderate tumor differentiation, portal vein tumor thrombus, microvascular invasion, cirrhosis, preoperative HBV-DNA loading>104 copies/mL and open surgery proportion of patients were higher than those in the non-recurrence group (P<0.05). Combined type 2 diabetes mellitus, portal vein tumor thrombus, microvascular invasion, preoperative HBV-DNA loading>104 copies/mL were the risk factors for recurrence of HCC(P<0.05). Conclusion: Compared with open surgery, laparoscopic surgery can reduce trauma, be more conducive to postoperative rehabilitation, and reduce perioperative complications and postoperative recurrence rate. Type 2 diabetes mellitus, portal vein tumor thrombus, microvascular invasion and preoperative HBV-DNA loading are the influencing factors of recurrence of HCC. |
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