手助式腹腔镜在肝脏切除中的价值  

Hand-assisted laparoscopic hepatectomy:is it worth doing?

作　　者：詹茜[1] 沈柏用[1] 彭承宏[1] 邓侠兴[1] 祝哲诚[1] 李宏为[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院,上海200025

出　　处：《腹腔镜外科杂志》2010年第11期806-810,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨手助式腹腔镜肝切除术的安全性、可行性与临床价值。方法:回顾分析2004年9月至2009年12月为82例患者行选择性腹腔镜肝切除术的临床资料,其中手助式腹腔镜手术57例,传统腹腔镜手术25例。并选择25例同期常规开腹肝切除的患者,对比分析手助式、完全腹腔镜及开腹肝切除术的差异。结果:3组患者的年龄、性别、肝硬化表现、术前实验室检查和肿瘤大小差异无统计学意义。与传统腹腔镜肝脏手术相比,手助式腹腔镜肝脏手术的手术时间较长[(189.5±47.1)m in vs.(155.1±54.9)m in],中转开腹率较低(4.0%vs.5.2%)。两组术后肝功能、并发症发生率及死亡率差异无统计学意义。传统腹腔镜组饮食恢复较早[(1.6±1.3)d vs.(2.5±1.5)d],住院时间较短[(5.6±5.1)d vs.(8.8±1.8)d]。与传统开腹手术相比,手助式腹腔镜肝脏手术的手术时间较长[(189.5±47.1)m in vs.(138.5±54.3)m in],但术中出血、术后肝功能、死亡率、并发症发生率及术后住院时间差异均无统计学意义。手助式腹腔镜组的饮食恢复也较早[(2.5±1.5)d vs.(3.6±1.5)d]。结论:手助式腹腔镜肝脏手术安全可行,但并无足够的证据表明手助式腹腔镜肝脏手术优于传统开腹手术。外科医师应积极掌握传统腹腔镜肝脏手术的技巧,手助式腹腔镜肝脏手术更适于经验较少的腹腔镜外科医师对初级腹腔镜技能的学习。Objective：This study was designed to perform a case-control study to compare the outcomes of hand-assisted laparoscopic liver surgery（HALS）,pure laparoscopic liver surgery（PLS） and conventional open surgery（OS）,and to determine what benefits HALS might have in liver surgery.Methods：A retrospective analysis was carried out of 82 patients who underwent HALS（n=57） or PLS（n=25） between Sep.2004 and Dec.2009 and their clinical data were compared with 25 cohort-matched open surgeries in the same period.Intraoperative and postoperative outcomes,including operative time,blood loss,conversion rate,postoperative liver function,time to resume diet,mortality,complication rate and postoperative hospital stay were assessed.Results：The three groups were well matched in terms of age,gender,the presence of cirrhosis,preoperative laboratory data and tumor size.Compared with PLS,HALS group had a significantly longer operative time [（189.5±47.1）min vs.（155.1±54.9）min] and lower conversion rate（4.0% vs.5.2%）.There was no significant difference between the two groups with regard to postoperative liver function,mortality or complication rates.The PLS group resumed an oral diet earlier [（1.6±1.3）d vs.（2.5±1.5）d] and stayed in hospital for a significantly shorter time [（5.6±5.1）d vs.（8.8±1.8）d].Compared with OS,HALS group also had a significantly longer operative time [（189.5±47.1）min vs.（138.5±54.3）min],but the blood loss,postoperative liver function,mortality,complication rates and postoperative hospital stay were similar in the two groups.The HALS group resumed an oral diet earlier [（2.5±1.5）d vs.（3.6±1.5）d].Conclusions：Our data presented support the feasibility and safety of HALS,but we haven＇t found evident improvement of HALS over the conventional OS.The surgeon＇s efforts should be probably addressed to master the PLS procedure.HALS can be considered as a technique that junior surgeons with minimal laparoscopic skills adopt in their learning curve

关 键 词：手助式腹腔镜 肝切除术 剖腹术 

分 类 号：R657.3[医药卫生—外科学]