基于倾向评分匹配的腹腔镜与开腹肝中叶切除术治疗中央型肝癌的疗效比较

肝癌电子杂志 ›› 2021, Vol. 8 ›› Issue (4): 17-20.

基于倾向评分匹配的腹腔镜与开腹肝中叶切除术治疗中央型肝癌的疗效比较

冷松遥, 曹利, 田峰, 王小军, 陈健, 郑树国, 李建伟^*

陆军军医大学西南医院肝胆外科,重庆 400038

收稿日期:2021-10-26 出版日期:2021-12-30 发布日期:2022-10-27
通讯作者: ^*李建伟,E-mail：lijianwei@tmmu.edu.cn
作者简介:冷松遥医师陆军军医大学西南医院肝胆外科

Laparoscopic versus open mesohepatectomy for centrally located hepatocellular carcinoma: a propensity score matching study

Leng Songyao, Cao Li, Tian Feng, Wang Xiaojun, Chen Jian, Zheng Shuguo, Li Jianwei^*

Department of Hepatobiliary Surgery, The Southwest Hospital of Army Medical University, Chongqing 400038, China

Received:2021-10-26 Online:2021-12-30 Published:2022-10-27

摘要/Abstract

摘要： 目的：基于倾向评分匹配（propensity score matching,PSM）比较腹腔镜与开腹肝中叶切除术治疗中央型肝癌的临床疗效。
方法：回顾性分析2011年1月至2017年12月行手术治疗的中央型肝癌患者130例,其中腹腔镜组60例,开腹组70例,分别接受腹腔镜或开腹解剖性肝中叶（Ⅳ、Ⅴ、Ⅷ段）切除术。对两组患者进行PSM后,比较两组患者近期及远期疗效。
结果：经PSM后每组各41例患者。腹腔镜组患者术中出血量少于开腹组患者,术后住院时间短于开腹组患者,且差异均有统计学意义（P<0.05）;两组患者手术时间、术中输血率及并发症发生率差异均无统计学意义（P>0.05）;两组患者3、5年总生存率及无瘤生存率差异均无统计学意义（P>0.05）。
结论：与开腹肝中叶切除术相比,腹腔镜肝中叶切除术治疗中央型肝癌术中出血更少,术后恢复更快,且远期疗效相当,是一种安全、可行的手术方式。

关键词: 腹腔镜, 肝中叶切除术, 中央型肝癌, 治疗结果

Abstract: Objective: To compare open and laparoscopic mesohepatectomy for centrally located hepatocellular carcinoma by propensity score matching (PSM).
Methods: The clinical data of 130 patients with centrally located hepatocellular carcinoma treated by surgery from January 2011 to December 2017 were collected. There were 60 patients and 70 patients in the laparoscopic group and the open group all treated by anatomical mesohepatectomy (Ⅳ,Ⅴ,Ⅷ segment) and the short-term and long-term outcomes were collected.
Results: There was no significant difference in baseline data between the two groups after matching by propensity score (P>0.05). Laparoscopy was associated with lower blood loss and shorter postoperative hospital stay (P<0.05). The operation time, blood transfusion rate and complications rate were similar in open and laparoscopic groups (P>0.05). The 3 and 5-year overall survival rates and disease-free survival rates were similar in open and laparoscopic groups (P>0.05).
Conclusion: Laparoscopic anatomic hepatectomy for centrally located hepatocellular carcinoma can be carried out safely with favorable short-term and long-term outcomes.

Key words: Laparoscopy, Mesohepatectomy, Centrally located hepatocellular carcinoma, Treatment outcomes

冷松遥, 曹利, 田峰, 王小军, 陈健, 郑树国, 李建伟. 基于倾向评分匹配的腹腔镜与开腹肝中叶切除术治疗中央型肝癌的疗效比较[J]. 肝癌电子杂志, 2021, 8(4): 17-20.

Leng Songyao, Cao Li, Tian Feng, Wang Xiaojun, Chen Jian, Zheng Shuguo, Li Jianwei. Laparoscopic versus open mesohepatectomy for centrally located hepatocellular carcinoma: a propensity score matching study[J]. Electronic Journal of Liver Tumor, 2021, 8(4): 17-20.

参考文献

[1] 余计赏, 吴帆, 谭国钳, 等. 肝中叶切除与半肝切除治疗中央型肝细胞癌效果比较的Meta分析[J]. 临床肝胆病杂志, 2019, 35(5): 1008-1013.
[2] XIAO Y, LI W, WAN H F, et al.Central hepatectomy versus major hepatectomy for patients with centrally located hepatocellular carcinoma: A meta-analysis[J]. Int J Surg, 2018, 52: 297-302.
[3] 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版)[J]. 传染病信息, 2020, 33(6): 481-500.
[4] 郑树国. 腹腔镜解剖性肝中叶切除术[J]. 中国普外基础与临床杂志, 2014, 21(8): 929-931.
[5] LEE S Y.Central hepatectomy for centrally located malignant liver tumors: A systematic review[J]. World J Hepatol, 2014, 6(5): 347-357.
[6] PENG L, ZHOU Z Y, XIAO W D, et al.Systematic review and meta-analysis of laparoscopic versus open repeat hepatectomy for recurrent liver cancer[J]. Surg Oncol, 2019, 28: 19-30.
[7] 朱斯维, 尹新民, 姚立波, 等. 腹腔镜治疗中央型肝肿瘤的探讨(附40例报告)[J]. 中华外科杂志, 2019, 57(7): 517-522.
[8] LI J B, WANG C D, SONG J L, et al.Mesohepatectomy Versus Extended Hemihepatectomies for Centrally Located Liver Tumors: A Meta-Analysis[J]. Sci Rep, 2017, 7(1): 9329.
[9] DUMRONGGITTIGULE W, HAN H S, AHN S.Laparoscopic versus Open Hepatectomy for Hepatocellular Carcinoma in Elderly Patients: A Single-Institutional Propensity Score Matching Comparison[J]. Dig Surg, 2020, 37(6): 495-504.
[10] CHEUNG T T, DAI W C, TSANG S H, et al.Pure Laparoscopic Hepatectomy Versus Open Hepatectomy for Hepatocellular Carcinoma in 110 Patients With Liver Cirrhosis: A Propensity Analysis at a Single Center[J]. Ann Surg, 2016, 264(4): 612-620.
[11] XIAO L, LI J W, ZHENG S G.Laparoscopic anatomical segmentectomy of liver segments Ⅶ and Ⅷ with the hepatic veins exposed from the head side (with videos)[J]. J Surg Oncol, 2016, 114(6): 752-756.
[12] HO K M, CHENG K C, CHAN F K.Laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma: A propensity case-matched analysis of the long-term survival[J]. Ann Hepatobiliary Pancreat Surg, 2021, 25(1): 1-7.
[13] ISHII T, HATANO E, FURUYAMA H, et al.Preventive Measures for Postoperative Bile Leakage After Central Hepatectomy: A Multicenter, Prospective, Observational Study of 101 Patients[J]. World J Surg, 2016, 40(7): 1720-1728.
[14] 陈汝福, 周泉波. 腹腔镜肝中叶切除术[J/OL]. 中华腔镜外科杂志(电子版), 2010, 3(6): 493-496.
[15] MORISE Z.Laparoscopic liver resection for the patients with hepatocellular carcinoma and chronic liver disease[J]. Transl Gastroenterol Hepatol, 2018, 3: 41.
[16] 虞洪. 腹腔镜肝切除术并发症及防治[J]. 中国实用外科杂志, 2017, 37(5): 577-579, 585.
[17] YOON Y I, KIM K H, CHO H D.Long-term perioperative outcomes of pure laparoscopic liver resection versus open liver resection for hepatocellular carcinoma: a retrospective study[J]. Surg Endosc, 2020, 34(2): 796-805.
[18] 张万广, 陈孝平. 腹腔镜肝切除从技术到理念的改变[J]. 腹腔镜外科杂志, 2017, 22(5): 321-324.
[19] XU H W, LIU F, LI H Y.Outcomes following laparoscopic versus open major hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a propensity score-matched analysis[J]. Surg Endosc, 2018, 32(2): 712-719.
[20] XIANG L, LI J, CHEN J, et al.Prospective cohort study of laparoscopic and open hepatectomy for hepatocellular carcinoma[J]. Br J Surg, 2016, 103(13): 1895-1901.