腹腔镜肝切除术与开腹肝切除术治疗原发性大肝癌的效果及安全性对比观察  

Comparison of the Efficacy and Safety of Laparoscopic Hepatectomy and Open Hepatectomy in the Treatment of Large Primary Liver Cancer

作　　者：张春艳[1] 李淑艳 阎莉 张建梅 王凯 祁付珍 ZHANG Chun-yan;LI Shu-yan;YAN Li;ZHANG Jian-mei;WANG Kai;QI Fu-zhen(Depatment of Operating Room,the First Hospital of Huai'an Affiliated to Nanjing Medical University,Huai'an,Jiangsu 223300,China;Depatment of Infection Management Division,the First Hospital of Huai'an Affiliated to Nanjing Medical University,Huai'an,Jiangsu 223300,China)

机构地区：[1]南京医科大学附属淮安市第一医院手术室,江苏淮安223300 [2]南京医科大学附属淮安市第一医院感染管理处,江苏淮安223300

出　　处：《临床误诊误治》2020年第12期86-90,共5页Clinical Misdiagnosis & Mistherapy

基　　金：江苏省卫生计生委医学科研课题(H201668)。

摘　　要：目的探讨腹腔镜肝切除术与开腹肝切除术治疗原发性大肝癌的效果及安全性。方法选取2014年1月—2016年12月我院收治的120例原发性大肝癌患者,据手术治疗方法的不同分为观察组62例和对照组58例,观察组予腹腔镜镜下肝切除治疗,对照组予开腹肝切除治疗。比较两组手术时间、术中出血量、重症监护室停留时间、术后开始下床活动时间、术后肛门排气时间、术后拔除引流管时间及术后住院时间;术后随访3年,观察两组术后并发症发生情况及总生存率、无复发生存率。结果观察组术中出血量少于对照组,术后重症监护室停留时间短于对照组,差异有统计学意义(P<0.01)。观察组术后开始下床活动时间、术后肛门排气时间、术后拔除引流管时间及术后住院时间均短于对照组(P<0.01)。随访3年,观察组术后总并发症发生率为11.29%显著低于对照组的25.86%(χ^2=4.250,P=0.039)。两组术后3年总生存率和无复发生存率比较差异均无统计学意义(P>0.05)。结论腹腔镜肝切除术治疗原发性大肝癌具有更好的近期疗效和安全性,可缩短患者术后恢复时间,减少术后并发症的发生,可作为临床首选治疗方案。Objective To investigate the efficacy and safety of laparoscopic hepatectomy and open hepatectomy in the treatment of large primary liver cancer(LPLC).Methods From January 2014 to December 2016,120 patients with LPLC treated in in our hospital were selected and divided into observation group(n=62)and control group(n=58)according to different surgical treatment methods.The observation group was treated with laparoscopic hepatectomy,and the control group was treated with open hepatectomy.The duration of operation,intraoperative blood loss,length of ICU stay,postoperative ambulation time,postoperative anal exhaust recovery time,postoperative drainage tube removal time and postoperative hospital stay were compared between the two groups.The postoperative complications,overall survival(OS)rate and recurrence-free survival(RFS)rate of the two groups were observed after 3 years of follow-up.Results The intraoperative blood loss of the observation group was less than that of the control group,and the length of ICU stay was shorter than that of the control group(P<0.01).The ambulation time after operation,recovery time of anal exhaust,postoperative drainage tube removal time and postoperative hospital stay in the observation group were shorter than those in the control group(P<0.01).At 3 years after follow-up,the total complication rate of the observation group was 11.29%,which was significantly lower than that of the control group(25.86%)(χ^2=4.250,P=0.039).There was no significant difference in 3-year OS rate and RFS rate between the two groups(P>0.05).Conclusion Laparoscopic hepatectomy has better short-term efficacy and safety in the treatment of LPLC.It can shorten the postoperative recovery time and reduce the incidence of postoperative complications,which,therefore,can be used as the first choice for clinical treatment of LPLC.

关 键 词：肝肿瘤 腹腔镜 开腹 肝切除术 治疗结果 手术后并发症 

分 类 号：R735.7[医药卫生—肿瘤]