腹腔镜与开腹肝切除术治疗原发性肝恶性肿瘤的临床对比研究  

(LH)for primary hepatic malignant tumors by comparing the intraoperative and postoperative recovery of laparoscopic and open hepatectomy for primary hepatic malignant tumors

作　　者：俞广进[1] 贾冉[1] 张超[1] 戴伟[1] 夏俊[1] 徐徽 YU Guang-jin;JIA Ran;ZHANG Chao(The first Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院肝胆胰外科一病区,合肥230022

出　　处：《肝胆外科杂志》2019年第5期338-340,388,共4页Journal of Hepatobiliary Surgery

摘　　要：目的通过比较腹腔镜与开腹两种不同肝切除术治疗原发性肝恶性肿瘤的术中情况及术后恢复情况,评估开展腹腔镜肝切除术(LH)治疗原发性肝恶性肿瘤的安全性和可行性.方法回顾性分析安徽医科大学第一附属医院肝胆胰外科一病区2017年3月至2019年6月接受肝切除术的111例原发性肝恶性肿瘤患者的临床资料.LH组患者37例,开腹肝切除术患者(OH组)74例,配对条件为年龄、病灶位置、手术方式.比较两组患者的手术时间、术中失血量等术中情况及术后禁食时间、肝功能变化、并发症发生情况及术后住院时间等术后恢复情况.结果两组患者的手术时间、术中失血量无明显差异(P>0.05),但是腹腔镜左外叶切除的手术时间及失血量明显少于开腹肝左外叶切除(P<0.01).禁食时间、术后住院天数LH组明显小(少)于OH组(P<0.01);术后第一天LH组谷草转氨酶(AST)和总胆红素(TBIL)好于OH组,但差异无统计学意义(P>0.05),OH组谷丙转氨酶(ALT)好于LH组,差异同样无统计学意义(P>0.05);术后第四天LH组的AST、ALT和TBIL均好于OH组,但仅AST差异有统计学意义(P<0.05),术后第七天LH组的AST、ALT和TBIL均好于OH组,但差异均无统计学意义(P>0.05).LH组术后胸腔积液3例,腹腔积液2例,术后并发症发生率为13.51%(5/37);OH组发生胸腔积液6例,切口感染2例,切口脂肪液化1例,腹腔积液4例,并发症发生率为17.57%(13/74).差异无统计学意义(P>0.05).结论在严格把握手术适应症、熟练掌握腔镜手术操作技术的前提下,LH治疗原发性肝恶性肿瘤是安全可行和值得推广的.特别是腹腔镜肝左外叶切除可取代传统开腹手术,可作为肝左外叶病变手术治疗的首选手术方式.Objective To evaluate the safety and feasibility of laparoscopic hepatectomy(LH)for primary hepatic malignant tumors by comparing the intraoperative and postoperative recovery of laparoscopic and open hepatectomy for primary hepatic malignant tumors.Methods The clinical data of 111 patients with primary hepatic malignant tumors who underwent hepatectomy from March 2017 to June 2019 in the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed.There were 37 patients in the LH group and 74 patients in the OH group.The matching conditions were age,location of lesions and operation methods.The operation time,blood loss,fasting time,liver function changes,complications and hospital stay were compared between the two groups.Results There was no significant difference in operation time and blood loss between the two groups(P>0.05),but the operation time and blood loss of laparoscopic left lateral lobectomy were significantly less than that of open left lateral lobectomy(P<0.01).The fasting time and hospitalization days in LH group were significantly shorter(less)than those in OH group(P<0.01);on the first day after operation,AST and TBIL in LH group were better than those in OH group,but there was no significant difference(P>0.05),ALT in OH group was better than that in LH group,and there was no significant difference(P>0.05).The AST,ALT and TBIL of LH group were better than those of OH group on the fourth day after operation,but only AST had significant difference(P<0.05).The AST,ALT and TBIL of LH group were better than those of OH group on the seventh day after operation,but there was no significant difference(P>0.05).There were 3 cases of pleural effusion and 2 cases of peritoneal effusion in LH group,and the incidence of complications was 13.51%(5/37);6 cases of pleural effusion,2 cases of incision infection,1 case of incision fat liquefaction,4 cases of peritoneal effusion in OH group,and the incidence of complications was 17.57%(13/74).There was no significant difference(P>0.05).Concl

关 键 词：肝切除术 腹腔镜 微创治疗 

分 类 号：R735.7[医药卫生—肿瘤]