CAJ | 학술논문

目的探讨腹腔镜肝切除术(laparoscopic hepatectomy,LH)在治疗肝癌中的临床价值.方法分析2002年1月至2007年12月86例肝癌患者的临床资料,按手术方式不同分为LH组、开腹肝切除术(open hepatectomy,OH)组.结果 86例中LH组36例、OH组50例.两组在切口长度、术中出血量、进食时间、术后住院天数、止痛药使用比较差异有统计学意义(分别t=-37.608、-2.396、-13.073、-4.283、x2=35.765,均P＜0.05),LH组优于OH组;术后第1、3天两组血清ALT、AST、ALP、r-GT、LDH及术后第5天凝血酶原时间、白蛋白改变比较差异有统计学意义(统计值分别为-3.465、-3.236、-3.470、-6.812、-4.837和-3.998、-2.894、-4.286、-7.887、-5.388、6.131、7.292,均P＜0.05);术后第5天ALT、AST、ALP、r-GT及术后第1、5天TBIL值比较差异有统计学意义(分别t=-4.795、-2.155、-3.442、-4.194、-2.712、-1.600,均P＜0.05),OH组高于LH组.手术时间、切除方式、总并发症及1年和3年生存率、无瘤生存率相比差异无统计学意义(t=-0.893,分别x2=0.066,0.026,0.468,0.156,0.106,2.732,均P＞0.05),LH组术后3年无瘤生存率50.0%,OH组为25%(x2=2.732,P=0.098).结论 LH治疗肝癌是安全的且近期疗效优于OH,远期疗效无差异.
목적 탐토복강경간절제술(laparoscopic hepatectomy,LH)재치료간암중적림상개치.방법 분석2002년1월지2007년12월86례간암환자적림상자료,안수술방식불동분위LH조、개복간절제술(open hepatectomy,OH)조.결과 86례중LH조36례、OH조50례.량조재절구장도、술중출혈량、진식시간、술후주원천수、지통약사용비교차이유통계학의의(분별t=-37.608、-2.396、-13.073、-4.283、x2=35.765,균P＜0.05),LH조우우OH조;술후제1、3천량조혈청ALT、AST、ALP、r-GT、LDH급술후제5천응혈매원시간、백단백개변비교차이유통계학의의(통계치분별위-3.465、-3.236、-3.470、-6.812、-4.837화-3.998、-2.894、-4.286、-7.887、-5.388、6.131、7.292,균P＜0.05);술후제5천ALT、AST、ALP、r-GT급술후제1、5천TBIL치비교차이유통계학의의(분별t=-4.795、-2.155、-3.442、-4.194、-2.712、-1.600,균P＜0.05),OH조고우LH조.수술시간、절제방식、총병발증급1년화3년생존솔、무류생존솔상비차이무통계학의의(t=-0.893,분별x2=0.066,0.026,0.468,0.156,0.106,2.732,균P＞0.05),LH조술후3년무류생존솔50.0%,OH조위25%(x2=2.732,P=0.098).결론 LH치료간암시안전적차근기료효우우OH,원기료효무차이.
Objective To evaluate the safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma(HCC). Methods From January 2002 through December 2007,86 HCC cases were divided into laparoscopic hepatectomy group and open hepatectomy group.Clinical data were analyzed. Results There were 36 cases in LH group,and 50 cases in OH group.Significant differences were noticed in the length of incision,operative blood loss,food-taking time,postoperative hospital stays,and analgesic usage between the two groups (respectively t =-37.608、-2.396、-13.073、-4.283 、x2 = 35.765,all P＜0.05),in which LH group was superior to OH group.Differences appeared in ALT,AST,ALP,r-GT and LDH on post-op day 1,and 3.APTT,ALB response on the fifth day after operation were different in the two groups (separately t =-3.465,-3.236,-3.470,-6.812,-4.837 and-3.998,-2.894,-4.286,-7.887,-5.388,6.131,7.292; all P ＜0.05);ALT,AST,ALP,r-GT value on the fifth day post-operation,and T-BIL on the day 1,5 post-operation were different in two groups (separately t =-4.795,-2.155,-3.442,-4.194,-2.712,-1.600,all P ＜0.05),Meanwhile,as the results all showed that,injuries were all less severe in LH than OH group.There were no significant differences between the two groups in operative time,resection method,overall complications,1-year,3-year survival rate,disease free survival (t =-0.893,separately x2 =0.066,0.026,0.468,0.156,0.106,2.732,all P ＞0.05) while 3-year survival rate in LH group and OH group were 50.0%,25% respectively (x2=2.732,P = 0.098). Conclusion Laparoscopic hepatectomy was safe and feasible for treatment of HCC,and its short-term efficacy was better than open hepatectomy.Furthermore,laparoscopic hepatectomy had promising long-term effectiveness.