腹腔镜肝切除治疗原发性肝癌的可行性研究

发布时间：2018-03-16 19:17

本文选题：腹腔镜肝切除术　切入点：开腹肝切除术　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析比较腹腔镜肝切除术(Laparoscopic Hepatectomy,LH)与开腹肝切除术(Open Hepatectomy,OH)治疗原发性肝癌的围手术期相关指标,探讨腹腔镜肝切除术治疗原发性肝癌的可行性。方法:回顾性分析在河北医科大学第四医院肝胆外科于2014年1月至2014年12月期间行肝脏切除术的73例原发性肝癌患者,其中34例的患者行腹腔镜肝切除术(称为LH组),39例的患者行开腹肝切除术(称为OH组)。这73例原发性肝癌的患者都符合腹腔镜肝切除的标准,进行手术治疗之前均遵循患者自愿原则,并且由同一组医师完成,术中选用自制肝门阻断带来阻断入肝血流。两组患者一般资料:年龄、性别、肝功能child分级、肿瘤直径、肿瘤切缘、切除方式、术前肝功能(ALB、ALT、AST)等差别没有统计学意义(P0.05)。对两组患者手术时间、术中肝门阻断时间、术中出血、总的住院费用、术后并发症、术后使用止疼药情况、术后肛门排气时间、腹腔引流时间、术后住院时间、术后肝功能(术后第3天的ALB、ALT、AST)等10项指标行统计学分析,比较LH组和OH组的差异。采用spss21数据进行统计分析,对于组间计量资料的比较采用独立样本t检验,组间计数资料采用卡方检验或Fisher确切概率,P0.05为有统计学意义。结果:所有病例手术过程均顺利,LH组无一例中转开腹,73例患者无一例死亡,术后均恢复良好出院。腹腔镜组和开腹组分别在手术时间(LH组140.59±34.77min,OH组127.56±36.40min,P=0.124);术中肝门阻断时间(LH组23.05±8.23min,OH组19.82±5.23min,P=0.054);术中出血量(LH组35.88±22.65ml,OH组36.80±10.42ml,P=0.83);总的住院费用(LH组55190.47±10175.66元,OH组57047.64±9098.24元,P=0.41);术后并发症(LH组无并发症,OH组有2例术后胸腔积液和2例术后手术切口脂肪液化,P=0.18)等方面上相比较,差别无统计学意义(P0.05)。腹腔镜组分别在术后使用止疼药情况(LH组12例应用止疼药、25例没有应用止疼药,OH组22例应用止疼药、14例没有应用止疼药,P=0.014);术后肛门排气时间(LH组3.15±0.50天,OH组4.41±0.59天,P=0.00);腹腔引流时间(LH组6.53±1.08天,OH组8.51±1.23天,P=0.00);术后住院时间(LH组7.29±0.97天,OH组9.07±1.30天,P=0.00);术后第3天肝功能情况(LH组ALB36.73±3.32g/L,OH组ALB34.93±3.43g/L,P=0.03。LH组ALT102.29±78.64U/L,OH组ALT167.41±84.97U/L,P=0.001。LH组AST44.88±19.09U/L,OH组AST66.78±36.62U/L,P=0.002)等方面上均优于开腹组,两组相比差别具有统计学意义(P0.05)。结论:LH相对传统的OH具有腹壁切口小、机体创伤小、疼痛轻、术后恢复快、住院时间明显缩短等优点,可明显改善肝癌患者围手术期状况。并且LH组和OH组相比,住院总的经济花费上无明显差异。因此,经过完善的术前准备,合适的病例选择情况下,腹腔镜肝切除术治疗原发性肝癌是微创、有效、安全可行的,较开腹肝切除术有明显的优势,值得在有条件开展此项目的医院推广。
[Abstract]:Objective: to compare the perioperative parameters of laparoscopic hepatectomy (LH) and open hepatectomy (OH) in the treatment of primary liver cancer. To explore the feasibility of laparoscopic hepatectomy in the treatment of primary liver cancer methods: a retrospective analysis of 73 patients with primary liver cancer underwent hepatectomy from January 2014 to December 2014 in the Department of Hepatobiliary surgery, 4th Hospital of Hebei Medical University, was carried out. Of these, 34 patients underwent laparoscopic hepatectomy (39 patients called LH group) underwent open hepatectomy (called OH group). All 73 patients with primary liver cancer met the criteria of laparoscopic hepatectomy. All patients followed the principle of voluntary operation before operation, and were completed by the same group of doctors. During the operation, self-made hepatic portal occlusion was used to block the blood flow into the liver. The general data of the two groups were age, sex, liver function child grade, tumor diameter, age, sex, liver function child grade, tumor diameter. There was no significant difference in tumor resection margin, resection method, preoperative liver function and ALB alt (P 0.05). The operation time, hepatic hilus occlusion time, intraoperative hemorrhage, total hospitalization cost, postoperative complications and postoperative analgesic drug use were not statistically significant in the two groups. The postoperative anus exhaust time, abdominal drainage time, postoperative hospitalization time, postoperative liver function (Albus ALTASTAST) were statistically analyzed, and the differences between LH group and OH group were compared. Spss21 data were used for statistical analysis. For the comparison of measurement data between groups, independent sample t-test was used. Results: none of 73 patients in the LH group had died in all the cases, and none of them had been transferred to laparotomy in all the cases, and there was no death in all the patients in the group of all the patients who had successfully undergone surgery, and there was no significant difference between the two groups in the data of counting data by chi-square test or Fisher. The laparoscopic group and the open group recovered well after operation. The LH group (140.59 卤34.77 min) and the LH group (127.56 卤36.40 min) (127.56 卤36.40 min), LH group (23.05 卤8.23 min), LH group (19.82 卤5.23 min), LH group (35.88 卤22.65 ml) h group (36.80 卤10.42 ml P0. 83), the total hospitalization fee, 55190.47 卤10175.66 yuan (OH) group, 57047.64 卤9098.24 yuan (P0. 424), respectively, were all recovered after operation, and the postoperative blood loss was 35. 88 卤22. 65 ml / h group (36. 80 卤10. 42 ml P0. 83), the total cost of hospitalization was 55190.47 卤10175.66 yuan and 57047.64 卤90 98. 24 yuan respectively. There were 2 cases of postoperative pleural effusion and 2 cases of postoperative incision fat liquefaction P0. 18 in the no complication group of LH group. The difference was not statistically significant (P 0.05). In the laparoscopic group, 12 cases were treated with anodyne and 25 cases were not treated with the painkiller (OH), and 14 cases did not use the painkiller P0. 014 in the laparoscopy group, and the time of anal exhaust after operation in the Laparoscopic group (n = 12) was less than that in the control group (n = 25). In LH group, 3.15 卤0.50 days after operation, 4.41 卤0.59 days in OH group, 6.53 卤1.08 days in OH group, 8.51 卤1.23 days in OH group, 7.29 卤0.97 days in OH group, 9.07 卤1.30 days in OH group, ALB36.73 卤3.32 g / L ALB34.93 卤3.43 g / L ALT102.29 卤78.64 U / L group in ALT102.29 卤78.64 U / L ALT102.29 group, ALT167.41 卤84.97 UL / L ALT102.29 group and 0.001 group in AST44.88 卤19.09 U / L ALT102.29 group, respectively. Conclusion compared with traditional OH, the difference between the two groups is statistically significant (P 0.05). Conclusion compared with the traditional OH, the two groups have the advantages of small incision in abdominal wall, small body trauma, mild pain, quick recovery after operation, and shorter hospital stay, etc. It can obviously improve the perioperative condition of patients with liver cancer. And there is no significant difference in the total cost of hospitalization between LH group and OH group. Laparoscopic hepatectomy is minimally invasive, effective, safe and feasible, and has obvious advantages over open hepatectomy.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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