腹腔镜肝切除手术与同期开腹手术治疗肝脏恶性肿瘤的单中心回顾性研究  

Laparoscopic hepatectomy vs open surgery in the treatment of hepatic malignant tumors

作　　者：郝晓沛 代坤甫 马帅 董亚东 田广金 李德宇 余海波 Hao Xiaopei;Dai Kunfu;Ma Shuai;Dong Yadong;Tian Guangjin;Li Deyu;Yu Haibo(Department of Hepatobiliary Surgery,Zhengzhou University People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院、河南省人民医院肝胆外科,450003

出　　处：《中华普通外科杂志》2019年第2期132-135,共4页Chinese Journal of General Surgery

基　　金：河南省科技厅基础与前沿技术基金资助项目(112300410037);河南省重点科技攻关计划基金资助项目(132102310385);郑州市重点实验室基金资助项目(2015-9-23).

摘　　要：目的探讨腹腔镜肝切除术治疗肝脏恶性肿瘤的可行性与安全性。方法136例肝癌患者分为两组,腹腔镜手术组(LR组)51例,开腹手术组(OR组)85例。分析两组患者术后血清酶学、炎性因子以及术后并发症情况。结果LR组手术时间明显长于OR组(252±123)min比(169±63)min;住院时间(10±5)d比(12±5)d和术中出血量LR组均少于OR组(381±156)ml比(523±325)ml(均P<0.05)。术后LR组ALT、AST、ALP均显著低于OR组[ALT:(227±101)U/L比(690±575)U/L),AST:(187±107)U/L比(551±529)U/L,ALP:(63±25)U/L比(86±40)U/L,均P<0.05)。凝血酶原时间(PT)LR组较OR组缩短[(14.3±0.8)s比(15.3±1.6)s,P=0.000)]。术后患者IL-6、TNF-α水平LR组较OR组低[IL-6:(154±31)pg/ml比(182±34)pg/ml,TNF-α:(22±6)pg/ml比(30±7)pg/ml,均P<0.05]。腹腔镜组术后并发症明显低于开腹组(3.9%比11.8%,P<0.05)。结论腹腔镜切除肝脏恶性肿瘤并发症少,炎性应激反应与肝脏损伤更轻。Objective To explore the feasibility and safety of laparoscopic hepatectomy in the treatment of hepatic malignant tumors. Methods 136 liver cancer patients were divided into: laparoscopic surgery group (LR group,51 cases) and open surgery group (OR group,85 cases).Serum enzyme,inflammatory factors and postoperative complications were compared between the 2 groups. Results The operative time of LR group was significantly longer than that of OR group (252±123) min vs.(169±63 min),hospitalization time (10±5) d vs.(12±5) d and intraoperative blood loss in LR group were lower than those in OR group (381±156) ml vs.(523±325) ml (all P<0.05).ALT,AST,ALP in LR group was significantly lower than that in OR group [ALT: (227±101) U/L vs.(690±575) U/L,AST: (187±107) U/L vs.(551±529) U/L,ALP: (63±25)U/L vs.(86 ±40)U/L,all P<0.05].Prothrombin time in LR group was shorter than that in OR group [(14.3±0.8) s vs.(15.3±1.6)s,P=0.000] .The postoperative IL-6,TNF- α in LR group was lower than that in OR group [ IL-6: (154±31)pg/ml vs.(182±34)pg/ml,TNF-α: (22±6) pg/ml vs.(30±7) pg/ml,all P<0.05].Postoperative complications in laparoscopic group were significantly lower than those in laparotomy group (3.9% vs.11.8%,P<0.05). Conclusions Laparoscopic resection of liver malignant tumors is safer and has less complications,lower inflammatory stress response and liver injury.

关 键 词：肝肿瘤 肝切除术 腹腔镜 

分 类 号：R735.7[医药卫生—肿瘤]