腹腔镜解剖性肝切除术与非解剖性肝切除术的前瞻性对比研究

目的探讨腹腔镜下解剖性肝切除术和非解剖性肝切除术治疗肝癌的临床疗效。 方法按照前瞻性随机对照试验选取本院2015年1月至2018年2月期间收治的106例肝癌患者进行，按照随机数字表法分为解剖组(行腹腔镜解剖性肝切除术)和非解剖组(行腹腔镜非解剖性肝切除术)各53例。采用SPSS20.0统计软件对数据进行分析，围术期指标、肝功能指标用( ±s)表示，采用独立t检验；术后并发症发生率、术后1年复发转移率和生存率组间比较用χ²检验；P<0.05为差异有统计学意义。 结果解剖组的手术时间明显长于非解剖组，但术中出血量、输血量明显减少，住院时间显著短于非解剖组(P<0.05)。非解剖组术后第1、3、7天血清ALT、TBIL值明显高于解剖组(P<0.05)；术后1、3天血清AST值解剖组低于非解剖组(P<0.05)。解剖组术后并发症发生率为7.5%低于非解剖组22.6%(P<0.05)。解剖组与非解剖组1年总体生存率分别为94.3%和88.6%，两组差异无统计学意义(P>0.05)；1年无瘤生存率分别为90.6%和75.5%(P＝0.038)，两组差异有统计学意义(P<0.05)。 结论相对于腹腔镜非解剖性肝切除术，腹腔镜解剖性肝切除术临床疗效更好，并有效提高1年无瘤生存率，值得在临床上进一步推广应用。

A prospective comparison study between laparoscopic anatomic and non-anatomic hepatectomy

ObjectiveTo investigate the clinical efficacy of laparoscopic anatomical and non-anatomical hepatectomy for liver cancer. MethodsAccording to the prospective randomized controlled trial, 106 patients with hepatocellular carcinoma admitted to our hospital from January 2015 to February 2018 were divided into the anatomical group (laparoscopic anatomical hepatectomy) and the non-anatomical group (laparoscopic non-anatomical hepatectomy) according to the random number table method, 53 cases in each group. Statistical analysis were performed by using SPSS20.0 software. Measurement data, such as Perioperative indicators and liver function indicators were expressed as ( ±s), and were examined by using independent t test. The incidence of complications, recurrence and metastasis rate and 1-year survival rate were analyzed by using 2 test. A P value <0.05 was considered as statistically significant difference. ResultsThe operation time in the anatomical group was much longer than that in the non-anatomical group, however the amount of bleeding and blood transfusion during the operation was significantly less and the hospital stay was significantly shorter than that in the non-anatomical group (P<0.05). The serum ALT and TBIL values in non-anatomical group were significantly higher than those in anatomical group on the POD 1, 3 and 7 (P<0.05), and the serum AST values in anatomical group were significantly lower than those in non-anatomical group on the POD 1 and 3 respectively (P<0.05). The incidence of postoperative complications was 7.5% in the anatomical group and 22.6% in the non-anatomical group. The overall incidence of postoperative complications in the anatomical group was lower than that in the non-anatomical group (P<0.05). The 1-year overall survival rates in the anatomical group and the non-anatomical group were 94.3% and 88.6% respectively, with no significant difference between the two groups (P>0.05); The 1-year tumor-free survival rates were 90.6% and 75.5% (P=0.038), respectively, wtih significant difference between the two groups (P<0.05). ConclusionCompared with laparoscopic non-anatomical hepatectomy, laparoscopic anatomical hepatectomy has better clinical effect and could effectively improve one-year disease-free survival rate, which is worthy of further clinical application.