机构地区:[1]南通大学附属医院肝胆外科,江苏南通226001
出 处:《肝胆胰外科杂志》2013年第1期5-8,12,共5页Journal of Hepatopancreatobiliary Surgery
基 金:江苏省"科教兴卫工程"医学领军人才和创新团队项目(LJ201134);江苏省"青蓝工程"创新团队项目(苏教师[2010]27号)
摘 要:目的评价完全腹腔镜下左肝部分切除术的临床应用优势。方法回顾性研究2009年7月1日至2012年10月31日我院手术切除治疗的76例左肝肿瘤患者,分腹腔镜手术组(15例,均为完全腹腔镜下手术)和开放手术组(61例),比较两组术中出血量、手术时间、术后肛门排气时间、术后住院时间、住院总费用、术后并发症发生率以及术后1、4 d ALT、ALB以及TBIL。结果两组患者年龄、术前肝功能无明显差异。腹腔镜组术中出血量少于开放组(176±59 mL vs 301±119 mL,P<0.05)、术后住院时间短于开放组(6.3±1.0 d vs 12.1±2.1 d,P<0.05)、术后肛门排气时间早于开放组(1.2±0.4 d vs3.3±0.6 d,P<0.05)、术后并发症发生率少于开放组(0%vs 32.8%,P<0.05)。腹腔镜组术后1、4 d ALT与ALB恢复情况明显好于开放组(1 d ALT:162.6±55.2 U/L vs 358.3±202.9 U/L,P<0.05、4 d ALT:68.2±33.5 U/L vs 156.8±130.7 U/L,P<0.05;1 d ALB:36.3±1.8 g/L vs 30.6±2.9g/L,P<0.05;4 d ALB:36.2±3.4 g/L vs 32.5±3.5 g/L,P<0.05),而TBIL两组比较差异无统计学意义(1 d:20.8±5.5μmol/L vs 21.2±5.1μmol/L,P>0.05;4 d:15.8±2.8μmol/L vs 15.2±2.7μmol/L,P>0.05)。两组手术时间(138±25 min vs 130±41 min,P>0.05)、住院总费用(34 764±5 748元vs 32 472±6 215元,P>0.05)差异均无统计学意义。结论完全腹腔镜下左肝部分切除术创伤小,患者术后恢复快,住院时间短,术后并发症少,同时并不延长手术时间,也不增加费用,安全可行,值得有条件单位推广。Objective To evaluate the advantages of the clinical application of complete laparoscopic partial left liver resection. Methods From July 1. 2009 to October 31. 2012, 76 cases of left liver tumor in our hospital treated by resection were divided into complete laparoscopic group (n=15) and open group (n=61). Clinical data were comparatively analyzed between two groups including blood loss, operation duration, anal exsufflation time after operation, days of postoperative hospital stay, total costs in hospital, the ratio of postoperative compli- cations and postoperative liver functions. Results No significant difference was found in age and preoperative liver functions between two groups. The blood loss during operation in laparoscopic group was less than that in open group (176 ± 59 mL vs 301 ± 119 mL, P〈0.05). Average postoperative hospital stay in laparoscopic group was shorter than that in open group (6.3 ± 1.0 d vs 12.1 ± 2.1 d, P〈0.05). Postoperative anal exsufflation time in laparoscopic group was earlier than that in open group (1.2 ± 0.4 d vs 3.3 ± 0.6 d, P〈0.05). The ratio of postoperative complications in laparoscopic group was less than that in open group (0% vs 32.8%, P〈0.05). Recovery of ALT and ALB in laparoscopic group was better than that in open group at 1, 4 d (1 d ALT: 162.6 ± 55.2 U/L vs 358.3 ± 202.9 U/L, P〈0.05, 4 d ALT: 68.2 ± 33.5 U/L vs 156.8 ± 130.7 U/L, P〈0.05; 1 d ALB:36.3 ± 1.8 g/L vs 30.6 ± 2.9 g/L, P〈0.05; 4 d ALB: 36.2 ± 3.4 g/L vs 32.5 ± 3.5 g/L, P〈0.05), but there was no significant difference in TBIL between two groups (1 d: 20.8 ± 5.5 μmol/L vs 21.2 ± 5.1 μmol/L, P〉0.05; 4 d: 15.8 ± 2.8 μmol/L vs 15.2 ± 2.7 μmol/L, P〉0.05). Similarly, there was no significant difference in operating duration (138 ± 25 min vs 130 ± 41 rain, P〉0.05), total hospital costs (34 764 ± 5 748 yuan vs 32 472 ± 6 215 yuan, P〉0.05) between two groups. Conclusion Damage of totally laparoscopic partial left
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