中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2014年
6期
464-467
,共4页
向伦建%李建伟%陈健%范毓东%郭鹏%郑树国
嚮倫建%李建偉%陳健%範毓東%郭鵬%鄭樹國
향륜건%리건위%진건%범육동%곽붕%정수국
肝肿瘤%腹腔镜检查%肝切除术
肝腫瘤%腹腔鏡檢查%肝切除術
간종류%복강경검사%간절제술
Liver neoplasms%Laparoscopy%Hepatectomy
目的 探讨腹腔镜肝切除术治疗大肝癌的临床疗效.方法 回顾性分析2009年1月至201 1年1月第三军医大学西南医院采用腹腔镜肝切除术治疗84例大肝癌患者的临床资料.术前CT检查显示肿瘤位于左半肝12例、肝左外叶9例、右半肝3例、肝右前叶11例、肝右后叶11例、肝Ⅴ段8例、肝Ⅵ段6例、肝Ⅶ段6例、肝Ⅴ和Ⅵ段8例、肝Ⅶ和Ⅷ段4例、肝Ⅳ段5例、肝Ⅰ段1例.术前超声造影检查结果显示:肿瘤直径为5.1 ～6.0 cm 46例、6.1 ～7.0 cm 12例、7.1 ～8.0cm 9例、8.1～9.0cm 7例、9.1～ 10.0 cm10例.根据术前评估肿瘤大小、位置、肿瘤距肝脏表面的距离及与重要管道结构的关系及术中探查结果选择性行解剖性或非解剖性肝切除术.患者术后行腹部影像学和血清学复查,复查时间为术后第1年每3个月1次,第2年每4个月1次,第3年每6个月1次,随访时间截至2014年1月.采用Kaplan-Meier法计算生存率.结果 84例患者中8例中转开腹手术,中转开腹率为9.5％(8/84),76例成功施行腹腔镜肝切除术.30例患者行解剖性肝切除术,54例患者行非解剖性肝切除术.患者手术时间为(240±132) min,术中出血量为(432±340) mL,围手术期输血率为10.7％ (9/84),肿瘤直径为(6.5±1.5)cm,切缘距肿瘤距离为(1.6 ±0.9)cm,术后胃肠道功能恢复时间为(3.0±0.5)d,术后住院时问为(11±3)d,术后并发症发生率为19.0％(16/84).术后病理检查结果均为肝细胞癌,其中高分化癌18例、中分化癌57例、低分化癌9例.83例患者(除1例围手术期死亡患者)获得随访,随访时间为2 ～48个月,中位随访时间为24个月.术后1、3年总体生存率分别为91％、80％,术后1、3年无瘤生存率分别为70％和56％.结论 腹腔镜肝切除术选择性应用于大肝癌患者安全、可行,近期疗效好.
目的 探討腹腔鏡肝切除術治療大肝癌的臨床療效.方法 迴顧性分析2009年1月至201 1年1月第三軍醫大學西南醫院採用腹腔鏡肝切除術治療84例大肝癌患者的臨床資料.術前CT檢查顯示腫瘤位于左半肝12例、肝左外葉9例、右半肝3例、肝右前葉11例、肝右後葉11例、肝Ⅴ段8例、肝Ⅵ段6例、肝Ⅶ段6例、肝Ⅴ和Ⅵ段8例、肝Ⅶ和Ⅷ段4例、肝Ⅳ段5例、肝Ⅰ段1例.術前超聲造影檢查結果顯示:腫瘤直徑為5.1 ～6.0 cm 46例、6.1 ～7.0 cm 12例、7.1 ～8.0cm 9例、8.1～9.0cm 7例、9.1～ 10.0 cm10例.根據術前評估腫瘤大小、位置、腫瘤距肝髒錶麵的距離及與重要管道結構的關繫及術中探查結果選擇性行解剖性或非解剖性肝切除術.患者術後行腹部影像學和血清學複查,複查時間為術後第1年每3箇月1次,第2年每4箇月1次,第3年每6箇月1次,隨訪時間截至2014年1月.採用Kaplan-Meier法計算生存率.結果 84例患者中8例中轉開腹手術,中轉開腹率為9.5％(8/84),76例成功施行腹腔鏡肝切除術.30例患者行解剖性肝切除術,54例患者行非解剖性肝切除術.患者手術時間為(240±132) min,術中齣血量為(432±340) mL,圍手術期輸血率為10.7％ (9/84),腫瘤直徑為(6.5±1.5)cm,切緣距腫瘤距離為(1.6 ±0.9)cm,術後胃腸道功能恢複時間為(3.0±0.5)d,術後住院時問為(11±3)d,術後併髮癥髮生率為19.0％(16/84).術後病理檢查結果均為肝細胞癌,其中高分化癌18例、中分化癌57例、低分化癌9例.83例患者(除1例圍手術期死亡患者)穫得隨訪,隨訪時間為2 ～48箇月,中位隨訪時間為24箇月.術後1、3年總體生存率分彆為91％、80％,術後1、3年無瘤生存率分彆為70％和56％.結論 腹腔鏡肝切除術選擇性應用于大肝癌患者安全、可行,近期療效好.
목적 탐토복강경간절제술치료대간암적림상료효.방법 회고성분석2009년1월지201 1년1월제삼군의대학서남의원채용복강경간절제술치료84례대간암환자적림상자료.술전CT검사현시종류위우좌반간12례、간좌외협9례、우반간3례、간우전협11례、간우후협11례、간Ⅴ단8례、간Ⅵ단6례、간Ⅶ단6례、간Ⅴ화Ⅵ단8례、간Ⅶ화Ⅷ단4례、간Ⅳ단5례、간Ⅰ단1례.술전초성조영검사결과현시:종류직경위5.1 ～6.0 cm 46례、6.1 ～7.0 cm 12례、7.1 ～8.0cm 9례、8.1～9.0cm 7례、9.1～ 10.0 cm10례.근거술전평고종류대소、위치、종류거간장표면적거리급여중요관도결구적관계급술중탐사결과선택성행해부성혹비해부성간절제술.환자술후행복부영상학화혈청학복사,복사시간위술후제1년매3개월1차,제2년매4개월1차,제3년매6개월1차,수방시간절지2014년1월.채용Kaplan-Meier법계산생존솔.결과 84례환자중8례중전개복수술,중전개복솔위9.5％(8/84),76례성공시행복강경간절제술.30례환자행해부성간절제술,54례환자행비해부성간절제술.환자수술시간위(240±132) min,술중출혈량위(432±340) mL,위수술기수혈솔위10.7％ (9/84),종류직경위(6.5±1.5)cm,절연거종류거리위(1.6 ±0.9)cm,술후위장도공능회복시간위(3.0±0.5)d,술후주원시문위(11±3)d,술후병발증발생솔위19.0％(16/84).술후병리검사결과균위간세포암,기중고분화암18례、중분화암57례、저분화암9례.83례환자(제1례위수술기사망환자)획득수방,수방시간위2 ～48개월,중위수방시간위24개월.술후1、3년총체생존솔분별위91％、80％,술후1、3년무류생존솔분별위70％화56％.결론 복강경간절제술선택성응용우대간암환자안전、가행,근기료효호.
Objective To investigate the clinical efficacy of laparoscopic hepatectomy for the treatment of large hepatocellular carcinoma (HCC).Methods From January 2009 to January 2011,84 patients with large hepatocellular carcinoma received laparoscopic hepatectomy at the Southwest Hospital,and their clinical data were retrospectively analyzed.Lesions were located at the left lobe in 12 cases,left lateral lobe in 9 cases,right lobe in 3 cases,right posterior lobe in 11 cases,right anterior lobe in 11 cases,segment Ⅴ in 8 cases,segment Ⅵ in 6 cases,segment Ⅶ in 6 cases,segment Ⅴ/Ⅵ in 8 cases,segment Ⅶ/Ⅷ in 4 cases,segment Ⅳ in 5 cases and segment Ⅰ in 1 case.According to the results of preoperative ultrasonography,the tumor diameter ranged between 5.1-6.0 cm in46 cases,6.1-7.0 cm in 12 cases,7.1-8.0 cm in9 cases,8.1-9.0 cm in7 cases,9.1-10.0 cm in 10 cases.Anatomical or non-anatomical hepatectomy was performed according to the results of preoperative assessment and operative exploration.Abdominal imaging examination and serologic examination were done once every 3 months at postoperative year 1,once every 4 months at postoperative year 2,once every 6 months at postoperative year 3.The follow-up ended in January 2014.The survival rate was calculated by Kaplan-Meier method.Results Eight patients were converted to laparotomy,and the rate of conversion to laparotomy was 9.5％ (8/84).Seventy-six patients received laparoscopic hepatectomy,including 30 patients received anatomical hepatectomy and 54 received non-anatomical hepatectomy.The operation time,volume of blood loss,perioperative blood transfusion rate,tumor diameter,resection margin,time for gastriontestinal function recovery,duration of postoperative hospital stay,incidence of postoperative complications were (240 ± 132) minutes,(432 ± 340) mL,10.7％ (9/84),(6.5±1.5)cm,(1.6±0.9)cm,(3.0±0.5)days,(11 ±3)days and 19.0％(16/84),respectively.All thepatients were comfirmed with HCC including 18 cases of high differentiated HCC,57 cases of moderate differentiated HCC and 9 cases of low differentiated HCC.One patient died perioperatively.Eighty-three patients were followed up for 2-48 months,the median follow-up time was 24 months,and the overall 1-and 3-year survival rates and the 1-and 3-year tumor-free survival rates were 91％,80％,70％ and 56％,respectively.Conclusion Laparoscopic hcpatcctomy is safe and feasible for selected patients with large hepatocellular carcinoma.
