完全腹腔镜与开腹手术切除Ⅶ和Ⅷ段肝肿瘤的临床对比研究  

Comparison of total laparoscopic vs open liver resection for tumors in segments Ⅶ and Ⅷ

作　　者：强勇[1,2] 陈桢[3] 王玮[1] 王东芝[1] 王刚[1] 王斐然[1] 陈钟[1] 

机构地区：[1]南通大学附属医院肝胆外科,江苏省226001 [2]湖北省荆门市第一人民医院普外科 [3]南通大学医学院

出　　处：《中华普通外科杂志》2015年第11期851-854,共4页Chinese Journal of General Surgery

基　　金：江苏省医学创新团队和领军人才基金资助项目（LJ201134）;江苏省临床医学科技专项基金资助项目（BL201406）

摘　　要：目的比较完全腹腔镜与开腹手术切除Ⅶ、Ⅷ段肝肿瘤的临床效果。方法回顾性分析2011年1月至2015年1月符合纳人标准接受手术治疗的Ⅶ、Ⅷ段肝肿瘤患者的临床资料，其中完全腹腔镜肝切除（1aparoscopic liver resection，LLR）17例，开腹肝切除（open liver resection，OLR）25例，比较2组间围手术期情况及近远期效果。结果LLR组在术后第1、3天血清丙氨酸转氨酶（alanine aminotransferase，ALT）水平、术后通气时间、术后3d腹腔引流量以及术后住院时间方面较OLR组具有明显优势（分别t=一3．075、一3．175、一2．499、一2．088、一2．419，均P〈0．05）。2组在输血率、切缘到肿瘤组织最小距离、并发症发生率、总医疗费用比较差异无统计学意义（χ2=1．437，t=一1．244，Y。=0．209，t=1．079，均P〉0．05）。虽然手术时间和术中失血量LLR组较OLR组增加（分别t=3．360、2．189，均P〈0．05），但恶性肿瘤患者术后随访其复发率和生存率比较差异无统计学意义（分别χ2=0．240、0．000，均P〉0．05）。结论完全腹腔镜和开腹手术切除Ⅶ、Ⅷ段肝肿瘤的治疗效果相当，但前者更具有微创优势。Objective To compare the clinical effect of total laparoscopic and open liver resection for tumors in segments Ⅶ and Ⅷ. Methods The clinical data of patients with tumors in segments Ⅶ and Ⅷ of the liver who met the inclusion criteria and received operation at Affiliated Hospital of Nantong University from January 2011 to January 2015 were retrospectively analyzed. Among these patients, there were 17 cases who received total laparoscopic liver resection （LLR group）, and 25 cases who received open liver resection （ OLR group）. Results LLR group has obvious advantages in aspects of the level of serum alanine transaminase （ALT） on 1st and 3rd day postoperation, the time anal exsufflation, the drainage volume of abdominal cavity in 3 days after operation and the postoperative hospital stay than those in OLR group （respectively t = - 3.075, - 3. 175, - 2. 499, - 2. 088, - 2. 419, all P 〈 0. 05）. There were no significant differences in blood transfusion rate, the resection margin to the tumor, the postoperative morbidity and the total medical cost between the two groups （χ2 = 1. 437, t = - 1. 244, ,χ2= 0. 209, t = 1. 079, all P 〉 0. 05 ）. Though the mean operative time and intraoperative blood loss of LLR group compared with OLR group increased obviously （ respectively t = 3. 360, 2. 189, all P 〈 0. 05 ） . During the postoperative follow-up, there were no significant differences in the postoperative recurrence rate and the long-term survival rate in patients with malignant tumors （ respectively χ2 = 0. 240, 0. 000, all P 〉 0. 05 ）. Conclusion The therapeutic effect of total laparoscopic and open liver resection are equal in segments Ⅶ and Ⅷ hepatectomy, while, LLR has advantages of less trauma.

关 键 词：肝肿瘤 肝切除术 腹腔镜 

分 类 号：R735.7[医药卫生—肿瘤]