CAJ | 학술논문

目的：分析腹腔镜左半肝切除治疗原发性肝癌的安全性与可行性。方法回顾性分析2007年至2014年第三军医大学西南医院肝胆外科行左半肝切除术治疗原发性肝癌患者93例的临床资料,其中腹腔镜左半肝切除术47例,开腹左半肝切除术46例。对比分析2种手术方式患者术中、围手术期及随访数据资料,评价腹腔镜左半肝切除术治疗原发性肝癌是否具有安全性与可行性。结果腹腔镜与开腹的肿瘤直径分别为(56.57±24.56) mm与(64.11±33.39) mm,P=0.218,差异无统计学意义。腹腔镜和开腹手术时间分别为(217.53±60.22) min与(306.80±119.91) min,P<0.05,差异有统计学意义。腹腔镜和开腹术中失血量分别为(350.21±197.98) mL与(556.74±471.41) mL,P<0.05,差异有统计学意义。术中输血率腹腔镜和开腹分别为12.8%与32.6%,P<0.05,差异有统计学意义。术后ICU时间、术后胃肠道恢复功能时间、术后住院时间腹腔镜均短于开腹左半肝切除,P<0.05,差异有统计学意义。术后并发症发生率腹腔镜与开腹分别为14.9%与23.9%, P=0.271差异无统计学意义。术后1年与3年生存率腹腔镜为91.5%、83.0%,开腹为84.8%、76.1%。术后1年与3年无瘤生存率腹腔镜为74.5%、59.6%,开腹为65.2%、54.3%。结论腹腔镜左半肝切除术治疗原发性肝癌是安全可行的,可作为左半肝切除治疗原发性肝癌的标准术式推广应用。
목적：분석복강경좌반간절제치료원발성간암적안전성여가행성。방법회고성분석2007년지2014년제삼군의대학서남의원간담외과행좌반간절제술치료원발성간암환자93례적림상자료,기중복강경좌반간절제술47례,개복좌반간절제술46례。대비분석2충수술방식환자술중、위수술기급수방수거자료,평개복강경좌반간절제술치료원발성간암시부구유안전성여가행성。결과복강경여개복적종류직경분별위(56.57±24.56) mm여(64.11±33.39) mm,P=0.218,차이무통계학의의。복강경화개복수술시간분별위(217.53±60.22) min여(306.80±119.91) min,P<0.05,차이유통계학의의。복강경화개복술중실혈량분별위(350.21±197.98) mL여(556.74±471.41) mL,P<0.05,차이유통계학의의。술중수혈솔복강경화개복분별위12.8%여32.6%,P<0.05,차이유통계학의의。술후ICU시간、술후위장도회복공능시간、술후주원시간복강경균단우개복좌반간절제,P<0.05,차이유통계학의의。술후병발증발생솔복강경여개복분별위14.9%여23.9%, P=0.271차이무통계학의의。술후1년여3년생존솔복강경위91.5%、83.0%,개복위84.8%、76.1%。술후1년여3년무류생존솔복강경위74.5%、59.6%,개복위65.2%、54.3%。결론복강경좌반간절제술치료원발성간암시안전가행적,가작위좌반간절제치료원발성간암적표준술식추엄응용。
Objective To evaluate the safety and feasibility of laparoscopic left hepatectomy in patients with primary hepatic carcinoma. Methods Retrospective analysis was conducted in clinical data of left hepatectomy from 2007 to 2014,including 47 cases of laparoscopic hepatectomy and 46 cases of open hepatectomy. The intraoperative and postoperative data of the two surgical methods were compared to evalu-ate whether laparoscopic left hepatectomy is safe and feasible. Results The tumor size were bigger in the open hepatectomy [(56. 57 ± 24. 56) mm vs. (64. 11 ± 33. 39) mm,P=0. 218]. The laparoscopic left hepatectomy resulted in shorter operation time [(217. 53 ± 60. 22) min vs.(306.80±119.91)min],andtherewasasignificantlydifference(P<0.05).Theintraoperativebloodlosswerelesserinthelaparo-scopic left hepatectomy [(350. 21 ± 197. 98) mL vs. (556. 74 ± 471. 41) mL],and there was a significantly difference (P<0. 05). The lap-aroscopic left hepatectomy had a smaller intraoperative blood transfusion rate (12. 8% vs. 32. 6%,P<0. 05). The length of ICU stay,time for gastroentestinal function recovery, postopetative hospital stay were shorter than those of open left hepatectomy (P<0. 05). There was no significant difference of postoperative complication rate between them (14. 9% vs. 23. 9%,P=0. 271). The survival rates of 1-and 3-year after operation in patients with laparoscopic left hepatectomy were 91. 5% and 83. 0% respectively,while 84. 8% and 76. 1% in patients un-derwent open hepatectomy. The tumor-free survival rates 1-and 3-year after operation were 74. 5% and 59. 6% in patients with laparoscopic left hepatectomy respectively,while 65. 2% and 54. 3% in patients underwent open hepatectomy. Conclusion Laparoscopic left hepatectomy for primary hepatic carcinoma is safe and feasible. Laparoscopic left hepatectomy could be a consideration as the standard surgical methods for hepatic carcinoma.