中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (05): 571-576.DOI: 10.19538/j.cjps.issn1005-2208.2024.05.17

• 论著 • 上一篇    下一篇

腹腔镜与开放手术治疗肝细胞癌伴有微血管侵犯病人预后对比研究

宋瑞鹏1，袁玉斌2，王永帅1，孟凡征1，张珅瑜1，刘连新1，王继洲1   

  1. 1中国科学技术大学附属第一医院肝胆外科，安徽合肥 230036；2菏泽市立医院肝胆外科，山东菏泽 274000
  • 出版日期:2024-05-01 发布日期:2024-05-17

  • Online:2024-05-01 Published:2024-05-17

摘要： 目的    探讨腹腔镜与开放手术治疗肝细胞癌伴有微血管侵犯病人的预后。方法    回顾性分析中国科学技术大学附属第一医院与菏泽市立医院2018年1月至2023年12月收治的479例肝细胞癌伴有微血管侵犯病人的临床资料，采用倾向性评分匹配（PSM）按1∶1最近邻匹配法匹配，匹配后腹腔镜手术组和开放手术组各172例。比较两组病人的总生存期（OS）及无瘤生存期，用Cox回归模型分析影响OS的危险因素。 结果    （1）PSM前，与开放手术组相比，腹腔镜手术组病人的OS更长（P＜0.001）；PSM后，腹腔镜手术组病人的总体生存期仍更长（P=0.026）。（2）PSM前，腹腔镜相比开放手术组，病人的无瘤生存期更长（P＜0.001）；PSM后，两组病人的无瘤生存期差异无统计学意义（P=0.310）。（3）PSM后，比较两组病人肝切除术复发后治疗，腹腔镜手术组再次根治性手术的比例高于开放手术组（P=0.010）。（4）PSM后，多因素Cox回归模型分析结果显示，肿瘤最大直径≥5 cm（HR=1.11，95%CI 1.05~1.17，P<0.001）是影响病人OS的独立危险因素，复发转移后行根治性手术治疗（HR=0.39，95%CI 0.16~0.92，P=0.031）、复发转移后行靶向或免疫治疗（HR=0.45，95%CI 0.27~0.78，P=0.004）是病人OS的保护因素。结论    与传统开放手术相比，腹腔镜手术治疗肝细胞癌合并微血管侵犯的病人复发转移后再次根治性手术的比例更高，病人的OS更长。

关键词: 腹腔镜手术, 开放手术, 肝细胞癌, 微血管侵犯

Abstract: Comparative analysis of prognosis of hepatocellular carcinoma with microvascular invasion treated by laparoscopy and open surgery        SONG Rui-peng*, YUAN Yu-bin, Wang Yong-shuai, et al. *Department of Hepatobiliary Surgery, the First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230036, China
Corresponding author: WANG Ji-zhou, E-mail: wangjoe@ustc.edu.cn 
Abstract    Objective    To investigate the prognosis of hepatocellular carcinoma patients with microvascular invasion treated by laparoscopic and open surgery.  Methods    Clinical data of 479 patients with hepatocellular carcinoma with microvascular invasion admitted to the First Affiliated Hospital of USTC and Heze Municipal Hospital from January 2018 to December 2023 were retrospectively analyzed. The patients were divided into a laparoscopic operation group and an open operation group. Propensity score matching (PSM) was used according to the 1∶1 nearest neighbor matching method, and there were 172 patients in each group of post laparoscopic surgery and open surgery after matching. Overall survival (OS) and tumor-free survival were compared between the two groups, and the risk factors of OS were analyzed by  the Cox regression model.  Results    (1) Before PSM, OS was longer in the laparoscopic surgery group compared with the open surgery group(P<0.001); After matching the PSM, the OS of patients in the laparoscopic surgery group was still longer (P=0.026). (2) Before PSM, disease-free survival was longer in the laparoscopy surgery group compared with the open surgery group (P<0.001); There was no significant difference in disease-free survival time between the two groups after matching the PSM (P=0.310). (3) After PSM, compared the treatment after recurrent hepatectomy between the two groups, the proportion of re-radical surgery in the laparoscopic surgery group was higher than that in the open surgery group (P=0.010). (4) After matching the PSM, the results of multivariate COX regression analysis showed that the maximum tumor diameter≥5 cm (HR=1.11, 95%CI 1.05-1.17, P<0.001) was the independent risk factor affecting the OS of patients, while radical surgery after recurrence and metastasis (HR=0.39, 95%CI 0.16-0.92, P=0.031), and targeted or immunotherapy after recurrence and metastasis (HR=0.45, 95%CI 0.27-0.78, P=0.004) were the protective factors for the OS of patients. Conclusion    Compared with traditional open surgery, laparoscopic surgery for patients with hepatocellular carcinoma complicated with microvascular invasion has a higher proportion of re-radical surgery after recurrence and metastasis, and the OS of patients is longer. 

Key words: laparoscopic surgery,  , open surgery, hepatocellular carcinoma, microvascular invasion