CAJ | 학술논문

目的对上海交通大学医学院附属瑞金医院既往行腹腔镜下肝切除的病例资料进行归纳总结,并对腹腔镜肝切除治疗肝脏恶性肿瘤的长期疗效作出初步的评价.方法 2004年9月-2009年5月共有75例肝脏恶性肿瘤患者实施腹腔镜肝切除术,对其病例资料、围术期数据、术后并发症及恢复情况、短期疗效、长期疗效进行分析总结.结果 75例行腹腔镜肝切除术的患者中,完全腹腔镜下肝切除术50例,手助式腹腔镜下肝切除22例,中转开腹3例.平均手术时间为(164.1±67.2)min,中位出血量为200 mL.术后1～6 d开始进食,1～3 d可下床,术后平均住院时间为(8.4±3.5)d.患者术后外周血白细胞计数、丙氨酸转氨酶、天冬氨酸转氨酶等指标均迅速恢复至正常或接近正常水平.4例(5.3%)患者出现术后并发症,其中腹腔感染1例,胆漏2例,胸腔积液1例.无1例手术死亡病例.24例患者术后经病理检查证实为肝细胞肝癌,其中2例中转开腹,另外22例行腹腔镜肝切除的肝细胞肝癌患者进行了9～58个月的随访.术后随访满3年的16例患者中,复发5例,其中4例死亡,1例健在;余11例患者无复发迹象.3年生存率为12/16.至今生存期最长的患者为58个月,无肿瘤复发迹象.结论腹腔镜肝切除是安全,有效的,其治疗肝细胞肝癌的根治性值得肯定,术后3年复发率和生存率的初步结果令人满意.
목적 대상해교통대학의학원부속서금의원기왕행복강경하간절제적병례자료진행귀납총결,병대복강경간절제치료간장악성종류적장기료효작출초보적평개.방법 2004년9월-2009년5월공유75례간장악성종류환자실시복강경간절제술,대기병례자료、위술기수거、술후병발증급회복정황、단기료효、장기료효진행분석총결.결과 75례행복강경간절제술적환자중,완전복강경하간절제술50례,수조식복강경하간절제22례,중전개복3례.평균수술시간위(164.1±67.2)min,중위출혈량위200 mL.술후1～6 d개시진식,1～3 d가하상,술후평균주원시간위(8.4±3.5)d.환자술후외주혈백세포계수、병안산전안매、천동안산전안매등지표균신속회복지정상혹접근정상수평.4례(5.3%)환자출현술후병발증,기중복강감염1례,담루2례,흉강적액1례.무1례수술사망병례.24례환자술후경병리검사증실위간세포간암,기중2례중전개복,령외22례행복강경간절제적간세포간암환자진행료9～58개월적수방.술후수방만3년적16례환자중,복발5례,기중4례사망,1례건재;여11례환자무복발적상.3년생존솔위12/16.지금생존기최장적환자위58개월,무종류복발적상.결론 복강경간절제시안전,유효적,기치료간세포간암적근치성치득긍정,술후3년복발솔화생존솔적초보결과령인만의.
Objective To analyze the clinical data of the patients undergoing laparoscopic hepatectomy in our hospital, and investigate the long-term efficacy of the laparoscopic hepatectomy for liver malignant tumors. Methods From Sep. 2004 to May 2009, a total of 75 patients received laparoscopic hepatectomy for malignant hepatic tumors. The clinical data, perioperative data, postoperative complications, recovery and short-and long- term efficacy were evaluated. Results Fifty of the 75 patients underwent total laparoscopic hepatectomy; 22 underwent the hand-assisted laparoscopic hepatectomy; and 3 patients were transferred to open surgery. Themean operative time was (164.1 ± 67.2) min and the mean blood loss was (442.1 ± 585.2) mL. All patients started eating 1 -6 days after the operation, and the mean hospital stay was (8.4 ± 3.5) d. Postoperative WBC and liver function indicators rapidly recovered to nearly normal level. Four cases (5.3%) had complications; abdominal infection in 1 case, bile leakage in 2 cases, and hydrothorax in 1 case. Twenty-two patients were diagnosed as HCC according to pathological findings and were followed up for a long time. Sixteen cases survived for more than 3 years; among them, 5 had recurrence, with 4 died and 1 still alive. No tumor recurrence was found in the rest cases. The 3 year survival rate was 12/16. Conclusion Laparoscopic liver resection is safe and effective, and it should be recommended for radical resection of hepatocellular carcinoma; the 3-year recurrence rate and survival rate are satisfactory.