CAJ | 학술논문

目的：探讨腹腔镜解剖性肝切除治疗肝细胞癌的可行性及安全性。方法回顾性分析广东省佛山市第一人民医院2008年1月至2014年9月实施腹腔镜肝切除治疗肝细胞癌的43例患者临床资料，从中筛选出以肝段为本的解剖性肝切除30例，观察患者手术时间、术中出血量、手术切缘、住院时间、术后并发症、近期及远期疗效等指标。结果30例患者中，实施右半肝切除2例，左半肝切除5例，肝Ⅴ、Ⅵ切除4例，肝Ⅴ切除1例，肝Ⅵ切除1例，肝Ⅵ、Ⅶ切除1例，左外叶联合左尾叶切除1例，左外叶切除14例，Ⅲ段切除1例；1例中转开腹。术中出血量257 ml，平均术中出血量50～850 ml；术中输血2例；手术时间238 min，平均手术时间120～420 min；手术切缘1．7 cm，平均手术切缘1～4 cm；术后住院时间7 d，平均术后住院时间4～15 d；发生术后并发症5例，经非手术治疗后均治愈；术后随访3～72个月；1、3、5年总的生存率分别为100％、73．4％、62．3％。结论腹腔镜解剖性肝切除治疗肝细胞癌安全、可行，具有创伤小、恢复快等优势，但应严格掌握手术适应证。
목적：탐토복강경해부성간절제치료간세포암적가행성급안전성。방법회고성분석광동성불산시제일인민의원2008년1월지2014년9월실시복강경간절제치료간세포암적43례환자림상자료，종중사선출이간단위본적해부성간절제30례，관찰환자수술시간、술중출혈량、수술절연、주원시간、술후병발증、근기급원기료효등지표。결과30례환자중，실시우반간절제2례，좌반간절제5례，간Ⅴ、Ⅵ절제4례，간Ⅴ절제1례，간Ⅵ절제1례，간Ⅵ、Ⅶ절제1례，좌외협연합좌미협절제1례，좌외협절제14례，Ⅲ단절제1례；1례중전개복。술중출혈량257 ml，평균술중출혈량50～850 ml；술중수혈2례；수술시간238 min，평균수술시간120～420 min；수술절연1．7 cm，평균수술절연1～4 cm；술후주원시간7 d，평균술후주원시간4～15 d；발생술후병발증5례，경비수술치료후균치유；술후수방3～72개월；1、3、5년총적생존솔분별위100％、73．4％、62．3％。결론복강경해부성간절제치료간세포암안전、가행，구유창상소、회복쾌등우세，단응엄격장악수술괄응증。
Objective To explore the feasibility and safety of laparoscopic anatomic hepatectomy for the patients with hepatocellular carcinoma(HCC).Methods The clinical data of forty three patients with HCC underwent laparoscopic anatomic hepatectomy at our hospital between Jan.2008 and Sep.2014 was retrospective analyzed.Among them,thirty cases received anatomic hepatectomy based on segment were analyzed. The operation time, blood loss during operation, resection margin, hospitalization time, complication and short term and long term survival outcome was observed.Results Among those 30 cases, 2 cases with right hemihepatectomy,5 cases with left hemihepatectomy,4 cases with combined segment Ⅴand Ⅵ hepatectomy,one case with segment Ⅴ hepatectomy,segment Ⅵ hepatectomy,segment Ⅵ and Ⅶhepatectomy,segment Ⅲ hepatectomy,combined left external lobe and left caudal lobe hepatectomy, respectively.Fourteen cases with left external lobe hepatectomy.One case with transform to open abdomen. The average blood loss during operation was 257 (range,50-850)ml.Two cases needed blood transfusion during operation.The average operation time was 238 (range,120-420)minutes.The average resection margin was 1.7(range,1-4)cm.The average hospitalization after operation was 7.0(range,4-15)days. There 4 cases with complications after operation,and all were cured without operation.The follow up time was 1 to 72 months.The overall survival rate for 1,3,5 years was 100%,73.4% and 62.3%, respectively.Conclusion Laparoscopic anatomic hepatectomy for the patients with HCC was safe and feasible with minimal invasive and fast recovery.However,the surgical indication should be strict.