CAJ | 학술논문

目的探讨腹腔镜手术治疗肝癌的临床价值.方法回顾性分析2007年3月至2009年10月第三军医大学西南医院采用腹腔镜手术治疗128例肝癌患者的临床资料.其中原发性肝癌116例,转移性肝癌12例.行腹腔镜肝切除术107例,单纯腹腔镜下RFA治疗15例,腹腔镜下门静脉右支结扎降期治疗6例.结果 107例行腹腔镜肝切除术患者中7例中转开腹手术,5例中转手助式腹腔镜肝切除术.规则性肝切除88例,包括左外叶切除21例、左半肝切除15例、超左半肝切除2例、中肝切除1例、右半肝切除11例、右后叶切除9例、单肝段切除29例;两个以上部位联合切除4例;非规则性肝切除15例.肝切除术的平均手术时间(228±92)min,术中平均出血量(393±213)ml,无手术死亡,16例术后出现并发症,术后平均住院时间(8±4)d.126例患者随访1～42个月,12例行腹腔镜肝切除术者于术后3～16个月死亡,术后平均生存时间(118±7)周,平均无瘤生存时间(105±7)周.行腹腔镜下BFA治疗的2例患者分别于术后9个月及11个月死亡;行腹腔镜下门静脉结扎的2例患者于术后行二期根治性切除.结论腹腔镜手术治疗肝癌安全可行,具有创伤小、恢复快的优点.
목적 탐토복강경수술치료간암적림상개치.방법 회고성분석2007년3월지2009년10월제삼군의대학서남의원채용복강경수술치료128례간암환자적림상자료.기중원발성간암116례,전이성간암12례.행복강경간절제술107례,단순복강경하RFA치료15례,복강경하문정맥우지결찰강기치료6례.결과 107례행복강경간절제술환자중7례중전개복수술,5례중전수조식복강경간절제술.규칙성간절제88례,포괄좌외협절제21례、좌반간절제15례、초좌반간절제2례、중간절제1례、우반간절제11례、우후협절제9례、단간단절제29례;량개이상부위연합절제4례;비규칙성간절제15례.간절제술적평균수술시간(228±92)min,술중평균출혈량(393±213)ml,무수술사망,16례술후출현병발증,술후평균주원시간(8±4)d.126례환자수방1～42개월,12례행복강경간절제술자우술후3～16개월사망,술후평균생존시간(118±7)주,평균무류생존시간(105±7)주.행복강경하BFA치료적2례환자분별우술후9개월급11개월사망;행복강경하문정맥결찰적2례환자우술후행이기근치성절제.결론 복강경수술치료간암안전가행,구유창상소、회복쾌적우점.
Objective To investigate the value of laparoscopy in the treatment of liver cancer.Methods The clinical data of 128 liver cancer patients who received laparoscopic surgery at Southwest Hospital from March 2007 to October 2009 were retrospectively analyzed.Of all patients,116 were with primary liver cancer,and 12 with metastatic liver cancer.There were 107 patients who received laparoscopie bepatectomy,15 received laparoscopic radiofrequency ablation(RFA)and 6 received laparoscopic ligation of the right branch of portal vein.Results Of the 107 patients who received laparoscopic bepatectomy,7 were converted to open surgery,and 5 were converted to hand-assisted laparoscopic hepatectomy.Anatomical hepatectomy was performed on 88 patients,including left lateral lobectomy on 21,left hemihepatectomy on 15,extended left hemihepatectomy on 2,medial lobectomy on 1,right hemihepatectomy on 11,right posterior lobeetomy on 9 and hepatic segmentectomy on 29.Combined hepatic resection was performed on 4 patients,and nonanatomical hepatectomy on 15.The mean oporatire time and blood loss were(228±92)minutes and(393±213)ml,with no operative mortality.The mean postoperative hospital stay was(8±4)days,and the incidence of complications was 15%(16/107).A total of 126 patients were followed up for 1-42 months,12 patients with laparoscopic hepatectomy died within 16 months,with the mean survival time of(118±7)weeks and the mean tumor free survival time of(105±7)weeks;2 patients with laparoscopic RFA died within 11 months:2 patients with laparoseopie ligation of the right branch of portal vein received two-stage radical resection.Conclusion Laparoscopic surgery is safe and feasible with the advantages of minimal operative trauma and quick recovery of patients when it is applied to the treatment of liver cancer.