肝胆胰外科杂志2025，Vol.37Issue(10)：655-665,11.DOI:10.11952/j.issn.1007-1954.2025.10.002
腹腔镜肝切除术与开腹肝切除术治疗BCLC 0/A期原发性肝细胞癌伴临床显著性门静脉高压症的安全性及有效性比较
Safety and efficacy of laparoscopic liver resection versus open liver resection for BCLC stage 0/A primary hepatocellular carcinoma with clinically significant portal hypertension
摘要
Abstract
Objective To compare the safety and efficacy of laparoscopic liver resection(LLR)versus ope liver resection(OLR)in patients with Barcelona Clinic Liver Cancer(BCLC)stage 0/A primary hepatocellular carcinoma(HCC)and clinically significant portal hypertension(CSPH).Methods A retrospective analysis was conducted on 276 patients with BCLC stage 0/A primary HCC and CSPH,who admitted to Tongji Hospital of Huazhong University of Science and Technology between March 2019 and December 2021.The cohort was stratified into the LLR group(n=141)and the OLR group(n=135).Propensity score matching(PSM),1:1 ratio was performed,resulting in 88 matched pairs.The perioperative data,postoperative complication incidence,and the postoperative survival were compared between the two groups.Cox proportional hazards regression models were employed to analyze risk factors for postoperative overall survival(OS)and disease-free survival(DFS).Results Prior to PSM,patients in the two groups demonstrated significant differences in ASA classification(P＜0.05).Compared with the LLR group,the OLR group exhibited higher proportion of patients with maximum tumor diameter ≥5 cm and with multiple tumors(P＜0.001).After PSM,all baseline characteristics between the matched two groups were comparable(P＞0.05).After PSM,the operative time in the LLR group was significantly longer than that in the OLR group[290(240,340)min vs 240(200,292)min,P＜0.001].Similarly,the hepatic portal occlusion time was prolonged in the LLR group[25(15,40)min vs 15(10,30)min,P＜0.001].However,the LLR group demonstrated superior postoperative recovery outcomes,as evidenced by significantly shorter duration of intravenous analgesia[4(3,5)days vs 5(4,7)days,P＜0.001],shorter time of gastrointestinal function recovery[2(1,2)days vs 2(2,3)days,P＜0.001],shorter time of drainage tube removal[5(4,6)days vs 6(5,10)days,P＜0.001],and shorter time of postoperative hospitalization[7(7,9)days vs 12(9,15)days,P＜0.001].The LLR group exhibited significantly lower postoperative incidence rate of anemia[44.3％(39/88)vs 63.6％(56/88),P＜0.05],blood transfusion requirement[3.4％(3/88)vs 15.9％(14/88),P＜0.05],and substantial pleural/abdominal effusion[8.0％(7/88)vs 27.3％(24/88),P＜0.001].Following PSM,the 1-,3-,and 5-year OS rates for the OLR group and the LLR group were 86.3％,64.7％,53.0％,and 87.5％,67.0％,57.6％,respectively,with no significant difference between the two groups(HR=1.09,95％CI 0.69 to 1.71,P=0.713).Similarly,the 1-,3-,and 5-year DFS rates for the OLR group and the LLR group were 70.9％,61.4％,51.0％,and 81.4％,69.5％,47.7％,respectively,with no statistically significant difference between the two groups(HR=0.98,95％CI 0.62 to 1.55,P=0.926).Multivariate Cox regression analysis identified that,PLT＜100×109/L and/or WBC＜4× 109/L,AFP levels ≥400 ng/mL,and tumor diameter≥5 cm were independent risk factors for OS(P＜0.05).Additionally,PLT＜100× 109/L and/or WBC＜4×109/L,and microvascular invasion(MVI)were independent risk factors for DFS(P＜0.05).Conclusion For patients with BCLC stage 0/A primary primary HCC and CSPH,both OLR and LLR demonstrates comparable safety and therapeutic efficacy.Compared with OLR,LLR exhibits advantages including shorter postoperative recovery time,reduced postoperative pain intensity,and lower incidence rates of postoperative complications,while maintaining equivalent long-term oncological outcomes.Multivariable Cox analysis identified PLT＜100×109/L and/or WBC＜4× 109/L,AFP levels ≥400 ng/mL,and tumor diameter ≥ 5 cm as critical prognostic risk factors for OS;PLT＜100×109/L and/or WBC＜4×109/L,and MVI as critical prognostic risk factors for DFS.关键词
肝细胞癌/临床显著性门静脉高压症/肝切除术/腹腔镜肝切除术/术后并发症/总生存期/无病生存期Key words
hepatocellular carcinoma/clinically significant portal hypertension/liver resection/laparoscopic liver resection/postoperative complication/overall survival/disease-free survival分类
临床医学引用本文复制引用
王金鹏,余俊,邵天胤,申雪晗,吴俣,董汉华,程琪,张志伟,陈孝平..腹腔镜肝切除术与开腹肝切除术治疗BCLC 0/A期原发性肝细胞癌伴临床显著性门静脉高压症的安全性及有效性比较[J].肝胆胰外科杂志,2025,37(10):655-665,11.基金项目
湖北陈孝平科技发展基金会——肝胆胰恶性肿瘤研究基金多中心重大专项(CXPJJH11800001-2018104) （CXPJJH11800001-2018104）
华中科技大学同济医院临床研究领航项目(2019CR202). （2019CR202）
