Objective To investigate the clinical efficacy of laparoscopic hepatectomy for the treatment of large hepatocellular carcinoma (HCC).Methods From January 2009 to January 2011,84 patients with large hepatocellular carcinoma received laparoscopic hepatectomy at the Southwest Hospital,and their clinical data were retrospectively analyzed.Lesions were located at the left lobe in 12 cases,left lateral lobe in 9 cases,right lobe in 3 cases,right posterior lobe in 11 cases,right anterior lobe in 11 cases,segment Ⅴ in 8 cases,segment Ⅵ in 6 cases,segment Ⅶ in 6 cases,segment Ⅴ/Ⅵ in 8 cases,segment Ⅶ/Ⅷ in 4 cases,segment Ⅳ in 5 cases and segment Ⅰ in 1 case.According to the results of preoperative ultrasonography,the tumor diameter ranged between 5.1-6.0 cm in46 cases,6.1-7.0 cm in 12 cases,7.1-8.0 cm in9 cases,8.1-9.0 cm in7 cases,9.1-10.0 cm in 10 cases.Anatomical or non-anatomical hepatectomy was performed according to the results of preoperative assessment and operative exploration.Abdominal imaging examination and serologic examination were done once every 3 months at postoperative year 1,once every 4 months at postoperative year 2,once every 6 months at postoperative year 3.The follow-up ended in January 2014.The survival rate was calculated by Kaplan-Meier method.Results Eight patients were converted to laparotomy,and the rate of conversion to laparotomy was 9.5％ (8/84).Seventy-six patients received laparoscopic hepatectomy,including 30 patients received anatomical hepatectomy and 54 received non-anatomical hepatectomy.The operation time,volume of blood loss,perioperative blood transfusion rate,tumor diameter,resection margin,time for gastriontestinal function recovery,duration of postoperative hospital stay,incidence of postoperative complications were (240 ± 132) minutes,(432 ± 340) mL,10.7％ (9/84),(6.5±1.5)cm,(1.6±0.9)cm,(3.0±0.5)days,(11 ±3)days and 19.0％(16/84),respectively.All thepatients were comfirmed with HCC including 18 cases of high differentiated HCC,57 cases of moderate differentiated HCC and 9 cases of low differentiated HCC.One patient died perioperatively.Eighty-three patients were followed up for 2-48 months,the median follow-up time was 24 months,and the overall 1-and 3-year survival rates and the 1-and 3-year tumor-free survival rates were 91％,80％,70％ and 56％,respectively.Conclusion Laparoscopic hcpatcctomy is safe and feasible for selected patients with large hepatocellular carcinoma.

Objective To evaluate the clinical efficacy of laparoscopic hepatectomy and open hepatectomy for the treatment of hepatocellular carcinoma.Methods Two hundred and sixteen patients with hepatocellular carcinoma who were admitted to the Chongqing Three Gorges Central Hospital from October 2014 to December 2017 were enrolled in this study,52 patients undergoing laparoscopic hepatectomy (laparoscopic group) and 164 patients undergoing open hepatectomy,52 patients (open group) were matched by propensity score matching method to reduce confounding bias.The operation time,tumor sizes,resection margin,time of hepatic inflow occlusion,volume of blood loss,blood transfusion,postoperative complication rate,drainage tube removal time,postoperative anal exhaust time,duration of postoperative hospital stay and survival rates were compared.T test was used for the measurement data in line with the normal distribution,and the results were represented by (Mean ± SD) tandard deviation;Wilcoxon test was used for the measurement data in the skewed distribution,and M(range) was used for represention,and the chi-square test or Fisher's exact probability test was used for the counting data.Kaplan-meier method was used to describe the survival curve,and log-rank test was used to compare the survival rate.Cox regression model was used to evaluate the risk factors affecting the survival of patients with hepatocellular carcinoma.Results All patients were recovered with no perioperative death.The operation time,tumor sizes,resection margin,time of hepatic inflow occlusion were (226.1 ±67.5) min,(49.2 ± 15.5) mm,(14.3 ± 4.9) mm,(34.1±18.1) min and (227.0 ±55.7) min,(49.4 ±16.6) mm,(14.6 ±4.0) mm,(38.2 ± 16.1) min,with no significant differences between the two groups(P ＞ 0.05).The volume of blood loss,blood transfusion,postoperative complication rate,drainage tube removal time,postoperative anal exhaust time,duration of postoperative hospital stay were 325(50-1 200) ml,11.5％,15.4％,(4.8 ±0.9) d,3(2-5) d,(11.9± 3.5) d and 375(100-2 000) ml,19.2％,23.1％,(5.9 ±0.8) d,4(3-5) d,(14.9 ±6.2) d,with significant differences between the 2 groups(P ＜0.05).1-and 3-year overall survival rates were 93.4％,83.7％ and 1-and 3-year disease-free survival rates were 87.7％,71.2％ in laparoscopic group;1-and 3-year overall survival rates were 94.1％,82.5％ and 1-and 3-year disease-free survival rates were 88.3％,70.8％ in open group,with no significant differences between the 2 groups(P ＞0.05).Cox regression analysis revealed that ICG R15,tumor size and tumor differentiation were independent risk factors of survival (hazard ratio ＞ 1,P ＜ 0.005).Conclusions Application of Laparoscopic hepatectomy for the treatment of selective hepatocellular carcinoma patients has better short-term efficacy than open hepatectomy and long-term efficacy is comparably.The propensity score matching can reduce confounding bias and have value for clinical research.

ObjectiveTo investigate the clinical application value of laparoscopic hepatectomy (LH) in hepatocellular carcinoma (HCC).MethodsClinical data of 159 patients with HCC undergoing LH in the Southwest Hospital of the Third Military Medical University between January 2010 and January 2012 were retrospectively analyzed. Among the patients, 135 were males and 24 were females with the average age of (52±12) years old. One hundred and forty-seven cases were with liver function of Child-Pugh Class A and 12 with Class B. The informed consents of all patients were obtained and the local ethical committee approval was received. Measures such as fully liver exposure, controlled low central venous pressure,first hepatic portal occlusion or regional hepatic vascular inflow occlusion, and hepatectomy with harmonic scalpel were used for bleeding control during the surgery. The rate of conversion to laparotomy, duration of operation, intraoperative blood loss, blood transfusion rate, hepatic inflow occlusion and postoperative complications of the patients were observed. The survival analysis was conducted using Kaplan-Meier survival curves. ResultsThe rate of conversion to laparotomy was 6.3%(10/159)including 1 case of right hepatic vein injury, 4 of middle hepatic vein injury, 3 of bleeding from liver dissection surface and 2 of positive incisal margin. The duration of operation, the median intraoperative blood loss and the perioperative blood transfusion rate were respectively (228±64) min, 450(50-1600) ml and 8.8%(14/159). Hepatic inflow occlusion was applied on 92 cases, and the inflow occlusion time was (37±15) min. The postoperative recovery time of gastrointestinal function was (2.5±0.6) d and the hospital stay was (10±3) d. The postoperative complication incidence was 12.6% (20/159), including 1 case died of liver failure 1 week after surgery. The postoperative 1-, 3-year overall survival rates were respectively 94%, 80%, and the 1-, 3-year disease-free survival rates were respectively 85%, 64%.Conclusion With appropriate bleeding control techniques, LH is safe and feasible for HCC, and can achieve good curative efficacy.