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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。
Objective To investigate the feasibility and safety of laparoscopic anatomical liver resection in the treatment of hepatocellular carcinoma. Methods The clinical data of 43 patients with hepatocellular carcinoma treated by laparoscopic liver resection from January 2008 to September 2014 in Foshan First People’s Hospital of Guangdong Province were retrospectively analyzed. The liver-based anatomic hepatectomy Thirty patients were observed the operation time, blood loss, surgical margin, hospitalization time, postoperative complications, short-term and long-term efficacy and other indicators. Results Among the 30 patients, 2 cases underwent right hemihepatectomy, 5 cases left hepatectomy, 4 cases liver Ⅴ and Ⅵ resection, 1 case liver Ⅴ resection, 1 case liver Ⅵ excision, 1 case liver Ⅵ and Ⅶ resection, One case was combined with the left lobe and the other was removed by the outer lobe. There were 14 cases with the left external lobectomy and 1 case with the third stage. One case was converted to laparotomy. The intraoperative blood loss was 257 ml and the average blood loss was 50 ~ 850 ml. Two patients underwent intraoperative blood transfusion. The operation time was 238 min and the average operation time was 120-420 min. The operative margin was 1.7 cm and the average operative margin was 1 ~ 4 cm ; Postoperative hospital stay 7 days, the average postoperative hospital stay 4 ~ 15 days; postoperative complications occurred in 5 cases, after non-surgical treatment were cured; postoperative follow-up 3 to 72 months; 1, 3, 5 years total The survival rates were 100%, 73.4%, 62.3% respectively. Conclusions Laparoscopic anatomic hepatectomy for the treatment of hepatocellular carcinoma is safe and feasible. It has the advantages of less trauma and faster recovery. However, surgical indications should be strictly controlled.