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目的:探讨腹腔镜解剖性肝切除治疗肝细胞癌的临床效果及安全性。方法:选择2011年2月~2013年8月在我院进行诊治的肝细胞癌患者90例,将其随机分为治疗组与对照组,每组各45例。治疗组采用腹腔镜解剖性肝切除治疗,对照组采用开腹解剖性肝切除,两组术后都常规化疗3个月,观察和比较两组术中出血量、术后肛门排气时间和术后住院时间,并发症的发生情况及术前后血清谷氨酸转移酶(ALT)与天冬氨酸转移酶(AST)的水平。结果:与对照组相比,治疗组的术中出血量、术后肛门排气时间和术后住院时间均明显降低或缩短(P<0.05),术后3个月的膈下积液、切口感染、肺部感染、胆漏的发生率明显降低(P<0.05)。两组术前血清ALT与AST值对比差异无统计学意义(P>0.05);术后1周,两组的ALT与AST值都明显升上(P<0.05);术后3个月,治疗组的ALT与AST值明显低于对照组(P<0.05)。所有患者随访到2015年8月,治疗组的中位生存期为(18.33±3.11)个月,而对照组为(12.46±2.19)个月,较治疗组明显缩短(P<0.05)。结论:腹腔镜解剖性肝切除治疗肝细胞癌具有更好的微创性,能减少近期并发症的发生,促进肝功能的恢复,且能够延长患者的生存时间。
Objective: To investigate the clinical effect and safety of laparoscopic anatomic hepatectomy in the treatment of hepatocellular carcinoma. Methods: Totally 90 patients with hepatocellular carcinoma who were diagnosed and treated in our hospital from February 2011 to August 2013 were randomly divided into treatment group and control group, with 45 cases in each group. The treatment group was treated by laparoscopic anatomic hepatectomy and the control group by laparotomy. The two groups were treated by conventional chemotherapy for 3 months after operation. The blood loss, postoperative anal exhaust time and operation Hospital stay, complications and preoperative and postoperative serum levels of glutamate synthase (ALT) and aspartate aminotransferase (AST). Results: Compared with the control group, the intraoperative blood loss, postoperative anal exhaust time and postoperative hospital stay were significantly reduced or shortened (P <0.05), subphrenic fluid 3 months after operation, incision Infection, pulmonary infection, the incidence of bile leakage was significantly reduced (P <0.05). There was no significant difference between the two groups in ALT and AST (P> 0.05). After 1 week, ALT and AST in both groups were significantly increased (P <0.05) Group ALT and AST values were significantly lower than the control group (P <0.05). All patients were followed up until August 2015, the median survival time of the treatment group was (18.33 ± 3.11) months, while that of the control group was (12.46 ± 2.19) months, significantly shorter than that of the treatment group (P <0.05). Conclusions: Laparoscopic anatomic hepatectomy for hepatocellular carcinoma has better minimal invasiveness, can reduce the incidence of recent complications, promote the recovery of liver function, and can prolong the survival time of patients.