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目的对上海交通大学医学院附属瑞金医院既往行腹腔镜下肝切除的病例资料进行归纳总结,并对腹腔镜肝切除治疗肝脏恶性肿瘤的长期疗效作出初步的评价。方法2004年9月—2009年5月共有75例肝脏恶性肿瘤患者实施腹腔镜肝切除术,对其病例资料、围术期数据、术后并发症及恢复情况、短期疗效、长期疗效进行分析总结。结果75例行腹腔镜肝切除术的患者中,完全腹腔镜下肝切除术50例,手助式腹腔镜下肝切除22例,中转开腹3例。平均手术时间为(164.1±67.2)min,中位出血量为200mL。术后1～6d开始进食,1～3d可下床,术后平均住院时间为(8.4±3.5)d。患者术后外周血白细胞计数、丙氨酸转氨酶、天冬氨酸转氨酶等指标均迅速恢复至正常或接近正常水平。4例(5.3%)患者出现术后并发症,其中腹腔感染1例,胆漏2例,胸腔积液1例。无1例手术死亡病例。24例患者术后经病理检查证实为肝细胞肝癌,其中2例中转开腹,另外22例行腹腔镜肝切除的肝细胞肝癌患者进行了9～58个月的随访。术后随访满3年的16例患者中,复发5例,其中4例死亡,1例健在;余11例患者无复发迹象。3年生存率为12/16。至今生存期最长的患者为58个月,无肿瘤复发迹象。结论腹腔镜肝切除是安全,有效的,其治疗肝细胞肝癌的根治性值得肯定,术后3年复发率和生存率的初步结果令人满意。
Objective To summarize the previous cases of laparoscopic liver resection in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and to make a preliminary assessment of the long-term efficacy of laparoscopic hepatectomy in the treatment of hepatic malignancies. Methods From September 2004 to May 2009, a total of 75 patients with hepatic malignancies underwent laparoscopic hepatectomy and analyzed their case data, perioperative data, postoperative complications and recovery, short-term efficacy and long-term efficacy . Results Among the 75 patients who underwent laparoscopic liver resection, there were 50 cases of complete laparoscopic hepatectomy, 22 cases of hand-assisted laparoscopic hepatectomy and 3 cases of laparoscopic radical open surgery. The average operation time was (164.1 ± 67.2) min and the median amount of bleeding was 200 mL. The patients started to eat from 1 to 6 days after operation, and were able to get out of bed after 1 to 3 days. The average postoperative hospital stay was (8.4 ± 3.5) days. Peripheral blood leucocyte count, alanine aminotransferase, aspartate aminotransferase and other indicators of patients recovered rapidly to normal or near normal levels. Four patients (5.3%) had postoperative complications, including 1 case of abdominal infection, 2 cases of bile leakage and 1 case of pleural effusion. No case of surgical death. Twenty-four patients were proved to be hepatocellular carcinoma by pathology after operation. Two of them were converted to open laparotomy. Another 22 patients with hepatocellular carcinoma undergoing laparoscopic hepatectomy were followed up for 9-58 months. Among the 16 patients who were followed up for 3 years, 5 were recurred, of which 4 were dead and 1 was alive; more than 11 patients showed no recurrence. 3-year survival rate of 12/16. So far the longest survival of patients for 58 months, no signs of tumor recurrence. Conclusions Laparoscopic hepatectomy is safe and effective. The curative effect of the laparoscopic hepatectomy on hepatocellular carcinoma is worthy of recognition. The initial 3-year relapse rate and survival rate are satisfactory.