Zheng Baijun,Cheng Jiwen,Gao Ya,et al.Safety,feasibility and short-term outcome of laparoscopic liver resection versus open liver resection for hepatoblastoma[J].Journal of Clinical Pediatric Surgery,2019,18(11):935-940.[doi:10.3969/j.issn.1671—6353.2019.11.008]
腹腔镜肝切除术与开腹肝切除术治疗肝母细胞瘤的临床效果比较
- Title:
- Safety,feasibility and short-term outcome of laparoscopic liver resection versus open liver resection for hepatoblastoma
- Keywords:
- Liver Neoplasms; Laparoscopy; Laparotomy; Hepatectomy; Treatment Outcome
- 分类号:
- R735.7;R726.1
- 摘要:
- 目的 探讨腹腔镜肝切除术（laparoscopic liver resection，LLR）治疗肝母细胞瘤（hepatoblastoma，HB）的安全性及可行性。方法 收集2012年1月至2019年5月在西安交通大学第二医院接受LLR和开腹肝切除术（open liver resection，OLR）的HB患儿临床资料并进行回顾性分析，比较术前资料、手术指标、围手术期并发症及术后随访结果。结果 符合入选标准的LLR患儿17例（为LLR组），OLR患儿26例（为OLR组），两组患儿在年龄、性别、血红蛋白、肝功能、甲胎蛋白、肿瘤位置、大小、数目及手术方式、PRETEXT分期、危险度分层等方面均无统计学差异（P>0.05）。与OLR组相比，LLR组手术时间更长[LLR组（246±47.4）min vs.OLR组（187±52.8）min，P<0.01]，术中出血量更少[LLR组（77.5±39.2）mL vs.OLR组（110.6±34.5）mL，P<0.01]，手术切口长度更短[LLR组（6.0±2.4）cm vs.OLR组（10.7±3.1）cm，P<0.01]。两组均获R0期切除且无一例围手术期死亡病例。术后LLR组肝功能恢复更快[术后第7天AST：LLR组（64.7±20.5）IU/L vs.OLR组（77.8±17.6）IU/L，P<0.05；术后第7天ALT：LLR组（72.2±16.3）IU/L vs.OLR组（86.4±23.2）IU/L，P<0.05]，镇静剂或止痛药使用次数更少[LLR组（3.3±1.0）次vs.OLR组（4.8±0.7）次，P<0.01]，术后禁食时间[LLR组（1.5±0.6）d vs.OLR组（2.8±0.5）d，P<0.01]及住院时间[LLR组（7.3±1.3）d vs.OLR组（10.6±2.1）d，P<0.01]更短。两组患儿术后严重并发症发生率（LLR组11.8%vs.OLR组11.5%）、再手术率（LLR组5.9%vs.OLR组3.8%）、肿瘤复发转移率（LLR组17.6%vs.OLR组19.2%）、3年无瘤存活率（LLR组75.0%vs.OLR组76.9%）均无显著性差异（P>0.05）。结论 采用LLR治疗HB安全可行，具有出血量少、创伤小、恢复快、切口美观的优点，且不会增加术后并发症发生率，近期疗效尚可，但远期疗效有待进一步观察。
- Abstract:
- Objective To explore the safety,feasibility and short-term outcome of laparoscopic versus open liver resection (LLR vs OLR) for hepatoblastoma (HB).Methods The perioperative and follow-up data of LLR (n=17) and OLR (n=26) for HB operations at the same period were analyzed respectively from January 2012 to May 2019.Results No significant inter-group differences existed in age,gender,hemoglobin concentration,liver function,alpha fetoprotein (AFP) level and size/number/location/PRETEXT stage of tumor (P>0.05).As compared with OLR group,estimated blood loss was less and mean operative time longer in LLR group (P<0.01).No perioperative mortality occurred in neither groups and all of them underwent R0 resection.After operation,liver function recovered more quickly (Day 7 post-operation,AST:LLR 64.7;20.5 vs OLR 77.8±17.6 IU/L,P<0.05; ALT:LLR 72.2±16.3 vs OLR 86.4±23.2 IU/L,P<0.05).Fasting time and length of stay were much shorter (P<0.01) in LLR group with less sedatives or painkillers needed(P<0.01).No inter-group difference existed in the incidence of severe complications(P>0.05).The 3-year event-free survival was 75.0% for LLR and 76.9% for OLR.No inter-group difference existed.The reoperative rate was 5.9% for LLR and 3.8% for OLR respectively (P>0.05).Conclusion As a safe and feasible option for pediatric HB,LLR offers the advantages of minimal intraoperative trauma,faster recovery and no higher incidence of postoperative complications.And its short-term outcome is similar to that of OLR.However,long-term outcomes should be further evaluated.
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备注/Memo
收稿日期:2019-09-01。
基金项目:创新人才推进计划-青年科技新星项目（编号：2018KJXX-050）
通讯作者:高亚,Email:ygao@mail.xjtu.edu.cn