肝胆胰外科杂志2025，Vol.37Issue(8)：505-510,6.DOI:10.11952/j.issn.1007-1954.2025.08.001
超重/肥胖肝细胞癌患者腹腔镜肝切除与开腹肝切除术后教科书式结局的比较
Comparison of textbook outcomes between laparoscopic liver resection and open liver resection in overweight or obese patients with hepatocellular carcinoma
摘要
Abstract
Objective To compare the textbook outcomes(TO)between laparoscopic liver resection(LLR)and open liver resection(OLR)in overweight or obese hepatocellular carcinoma(HCC)patients.To analyze the risk factors for TO after hepatectomy in overweight or obese patients with HCC.Methods The clinical data of overweight or obese HCC patients who underwent primary liver resection at West China Hospital and Ziyang Central Hospital from 2014 to 2023 were retrospectively analyzed.Based on the surgical approach,patients were divided into the LLR group and the OLR group.Propensity score matching(PSM)was used to balance baseline characteristics between the two groups.The TO achievement rate and each item of TO were compared between the two groups.Logistic regression was used to analyze the independent risk factors for postoperative TO.Results A total of 1277 patients were enrolled in this study,of whom 949(74.3%)patients received OLR and 328(25.7%)patients received LLR.Among the 1277 patients,831(65.1%)patients achieved TO.Befor PSM,the TO achievement rate in the LLR group was significantly higher than that in the OLR group(75.6%vs 61.4%,χ2=21.555,P<0.001).After PSM,the TO achievement rate in the LLR group was significantly higher than that in OLR group(75.8%vs 68.7%,χ2=11.571,P=0.044);Further analysis indicated that the proportion of patients with prolonged hospitalization time in the OLR group was significantly higher than in the LLR group(25.8%vs 15.0%,P<0.001);The incidence of severe 30-day postoperative complications,mortality within 90 days after surgery,perioperative blood transfusion,non-R0 resection,and re-hospitalization within 30 days after discharge were similar between the two groups(P>0.05).Logistic regression analysis confirmed that,albumin-bilirubin with grade 2(OR=1.989,95%CI 1.527 to 2.591,P<0.001),tumor size>5 cm(OR=1.685,95%CI 1.315 to 2.160).P<0.001),microvascular invasion(OR=1.377,95%CI 1.070 to 1.773,P=0.013),poor tumor differentiation(OR=1.463,95%CI 1.021 to 2.097,P=0.038)and OLR(OR=1.680,95%CI 1.250 to 2.257,P<0.001)were independent risk factors for non-TO after liver resection.Conclusion For overweight or obese HCC patients,LLR offered an advantage in TO achievement than OLR.This advantage was mainly attributed to lower proportion of prolonged hospitalization time after LLR.OLR was an independent risk factor for overweight or obese HCC patients to achieve TO after surgery.LLR should be considered as a priority for overweight or obese patients with HCC.关键词
肝细胞癌/腹腔镜肝切除/开腹肝切除/教科书式结局/危险因素Key words
hepatocellular carcinoma/laparoscopic liver resection/open liver resection/textbook outcome/risk factor分类
医药卫生引用本文复制引用
董文文,覃莉,邱占成,周颖,陈廷昊,李川..超重/肥胖肝细胞癌患者腹腔镜肝切除与开腹肝切除术后教科书式结局的比较[J].肝胆胰外科杂志,2025,37(8):505-510,6.基金项目
四川省自然科学基金(2024NSFSC0637). （2024NSFSC0637）
