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目的探讨腹腔镜肝切除术在治疗非边缘部位小肝癌中的临床应用价值。方法对笔者所在医院2008年3月至2011年4月期间34例行腹腔镜肝切除术的非边缘部位小肝癌患者的临床资料进行回顾性分析。结果 34例患者中32例在不阻断肝血流情况下完成腹腔镜肝切除术,2例中转开腹。手术时间为(162±65)min(100～220 min),术中出血量为(295±166)ml(100～750 ml)。术后并发肝创面出血2例、腹水2例,无胆瘘、感染、CO2气栓等并发症发生,无围手术期死亡病例。术后住院时间为(6±2)d(4～9 d)。术后随访(23±7)个月(5～42个月),13例出现肝内非原位复发,术后1年生存率为90.6%(29/32),无瘤生存率为75.0%(24/32)。结论腹腔镜肝切除对部分非边缘部位小肝癌是一种安全有效的微创治疗方法,可考虑作为肝癌治疗的选择术式之一。
Objective To investigate the clinical value of laparoscopic hepatectomy in the treatment of non-border small hepatocellular carcinoma. Methods A retrospective analysis was performed on the clinical data of 34 patients with non-border small hepatocellular carcinoma who underwent laparoscopic liver resection from March 2008 to April 2011 in our hospital. Results 32 of the 34 patients underwent laparoscopic hepatectomy without interruption of hepatic blood flow, and 2 were converted to open laparotomy. The operation time was (162 ± 65) min (100-220 min) and the blood loss was (295 ± 166) ml (100-750 ml). There were 2 cases of postoperative liver wound hemorrhage, 2 cases of ascites, no complications of biliary fistula, infection, CO2 gas embolism, and no perioperative deaths. The postoperative hospital stay was (6 ± 2) d (4 to 9 days). The patients were followed up for 23 ± 7 months (range, 5 to 42 months). Noninvasive intrahepatic recurrence was found in 13 cases. The 1-year survival rate was 90.6% (29/32) and the tumor-free survival rate was 75.0% (24/32). Conclusions Laparoscopic hepatectomy is a safe and effective minimally invasive treatment for some non-marginal small hepatocellular carcinoma and may be considered as one of the surgical options for the treatment of liver cancer.