腹腔镜与开腹肝左叶血管瘤切除术的临床疗效对比  

Laparoscopic resection versus laparotomy for treatment of left hepatic hemangioma

作　　者：陈少华 李会星[2] 梁雨荣[2] CHEN Shaohua;LI Huixing;LIANG Yurong(The First Department of General Surgery, Affiliated Hospital to Chifeng College, Chifeng 024005, Inner Mongolia Autonomous Region, China;Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, 100853, China)

机构地区：[1]赤峰学院附属医院普外一科,内蒙古赤峰024005 [2]解放军总医院肝胆外科,北京100853

出　　处：《解放军医学院学报》2018年第5期388-391,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的比较腹腔镜肝左叶血管瘤切除术与开腹手术的临床疗效。方法回顾性分析2014年1月-2017年1月于赤峰学院附属医院普外一科实施肝血管瘤切除术的患者107例,根据手术方式的不同分为腹腔镜组和开腹组。比较两组患者术前一般情况、手术情况及术后恢复情况等指标差异。结果两组患者的性别、年龄、术前转氨酶水平、血清白蛋白、血清总胆红素水平等基线资料差异无统计学意义(P均>0.05);两组的平均手术时间及平均住院费用无统计学差异(P均>0.05);腹腔镜组平均术中出血量[(240.6±82.6)ml vs(286.8±91.4)ml,P=0.008]、术后谷丙转氨酶[(146.3±38.1)U vs(182.7±49.4)U,P=0.001]、谷草转氨酶[(173.7±42.6)U vs(217.2±55.8)U,P=0.000]、术后排气时间[(2.8±1.3)d vs(5.4±1.9)d,P=0.000]及术后住院时间[(8.4±1.7)d vs(11.2±2.6)d,P=0.000]均少于开腹组;在术后并发症方面,腹腔镜组术后切口液化、切口感染的发生率分别为2.2%、0,均显著低于开腹组的18.0%、9.8%(P均<0.05)。结论腹腔镜肝血管瘤切除较开腹手术具有创伤小、术后恢复快、并发症少等优点,控制好腹腔镜手术的适应证能够使患者临床获益更多。Objective To compare the effect of laparoscopic resection versus laparotomy for left hepatic hemangioma. Methods One hundred and seven patients received hepatic hemangioma resection in the first department of general surgery in Hospital Affiliated to Chifeng College from January 2014 to January 2017 were enrolled in this study. They were divided into laparoscopic group and laparotomic group according to surgical method. Then the general condition, perioperative indicators were compared between the two groups. Results There was no statistical difference in gender, age, preoperative aminotransferase level, serum albumin, serum total bilirubin（all P 〉0.05）. But the amount of intraoperative bleeding [（240.6±82.6）ml vs（286.8±91.4）ml, P=0.008], postoperative ALT level [（146.3±38.1） U vs（182.7±49.4） U, P=0.001], postoperative AST level [（2.8±1.3） d vs（5.4±1.9） d, P=0.000], postoperative exhausting time [（2.8±1.3） d vs（5.4±1.9） d, P=0.000] and postoperative hospitalization time [（8.4±1.7） d vs（11.2±2.6） d, P=0.000] of laparoscopic group were significantly less than those of laparotomic group. In addition, the incidences of incision liquefaction and incision infection of laparoscopic group were 2.2% and 0 respectively, which were significantly lower than 18.0% and 9.8% of laparotomic group（all P〈0.05）. Conclusion Laparoscopic resection of hepatic hemangioma has advantages of smaller incision, faster postoperative recovery and fewer complications over laparotomy. Surgeons should identify indications appropriately, then more patients can benefit from laparoscopic surgery.

关 键 词：肝血管瘤 手术治疗 腹腔镜 开腹 

分 类 号：R575[医药卫生—消化系统]