目的 探讨腹腔镜肝切除术在老年肝细胞癌患者应用的可行性及临床疗效.方法2013年1月至2015年12月在福建医科大学附属第一医院肝胆胰外科实施腹腔镜肝切除术老年肝细胞患者29例,以性别、肿瘤数目及肝切除方式等指标进行1:2配对,共有58例老年肝细胞癌患者作为对照组接受传统开腹肝切除术.比较两组患者一般临床资料、术中、术后恢复及术后生存情况.结果腹腔镜组术后住院时间更短(9.1±3.8)与(11.8±5.1)d,t=-2.66,P<0.05),肝门阻断率更低(34.5％ 与60.3％,χ2=5.18,P<0.05),且腹腔引流管拔除时间更早(4.2±1.9)与(5.4±2.1)d,t=-2.48,P<0.05).腹腔镜组和开腹组总生存期分别为37.08和38.72个月(t=0.72,P=0.789),无瘤生存期分别为29.00和27.49个月(t=0.53,P=0.467),差异均无统计学意义.结论老年人腹腔镜肝细胞癌切除术可与传统开腹手术达到相同根治效果,且具有较好的近期疗效,显示明显的微创优势.%Objective To evaluate the feasibility and efficacy of laparoscopic liver resection (LLR) in elderly patients with hepatocellular carcinoma (HCC). Methods Twenty-nine elderly patients undergoing laparoscopic liver resection (LLR) and 58 elderly patients receiving open liver resection (OLR) for HCC were included from January 2013 to December 2015 in our department of Fujian Medical University. Two groups were 1:2 matched for gender ,tumor numbers ,and operative procedure.Besides ,general clinical data ,intraoperative data ,postoperative recovery ,and postoperative survival were compared. Results The postoperative hospital stay was shorter in the LLR group [(9.1±3.8)days]thanintheOLRgroup[(11.8±5.1)days](t= -2.66,P<0.05).Theincidence of portal triad clamping was lower in the LLR group than in the OLR group (34.5％ vs.60.3％ ,χ2 =5.18 ,P<0.05). The removal time of abdominal drainage tube was earlier in the LLR group (4.18 ± 1.94)days than in the OLR group (5.4 ± 2.1)days (t= -2.48 ,P<0.05). The overall survival (OS) showed no difference (37.08 months vs.38.72 months ,t=0.72 ,P=0.789). The disease-free survival (DFS) showed no difference (29.00 months vs.27.49 months ,t=0.53 ,P=0.467). Conclusions LLR in elderly patients with HCC can achieve the same long-term outcome as the conventional open hepatectomy ,and LLR has better short-term outcomes with obvious advantages of minimal invasion.
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