84例腹腔镜与开腹肝切除术临床分析

发布时间：2018-02-07 12:11

本文关键词： 腹腔镜下肝切除术开腹肝切除术学习曲线　出处：《山东大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：通过腹腔镜下肝切除术(laparoscopic hepatectomy, LH)与开腹肝切除术(open hepatectomy,OH)术中情况及术后恢复情况的比较与分析,评估早期LH的安全性及可行性,并为后期LH的开展提供参考。材料及方法：本研究收集了自2012年1月至2015年3月在山东省立医院器官移植肝胆外二科实行肝切除术的84例患者的临床资料,其中腹腔镜肝切除术42例(LH组),开腹肝切除术42例(OH组),LH组肝脏病损包括良性疾病20例(47.6%),恶性疾病22例(52.4%),男女之比为11：10；OH组肝脏病损包括良性疾病17例(40.5%),恶性疾病25例(59.5%),男女之比为12：9。两组患者需在年龄、病变位置和病变大小、术前肝功能Child-Pugh分级以及手术方式等方面处于同一水平,所有患者均不合并心肺肾等严重器质性病变,手术均由相同年资的副高级以上医师主刀完成。回顾性比较和分析LH组和OH组患者的手术时间、术中失血量、术中输血量、术中肝门阻断率等术中情况以及术后肝功指标、术后输血量、术后3天腹腔引流量、并发症发生率、术后进食时间以及术后住院天数等术后恢复情况,总结与OH相比早期LH的优势和不足；分析LH组手术时间和术中失血量与手术方式和手术台次(手术经验)的关系,并建立腹腔镜肝切除术的学习曲线,为进一步开展腹腔镜手术提供参考。结果：84例患者手术过程顺利,术后均恢复良好出院,无1例死亡。其中LH组与OH组相比,手术时间(225.6±83.3 vs 140.4±54.8)明显延长,且有统计学意义(P0.05)；术中失血量(292.4±333.3 vs 286.9±218.9,P=0.93)及术中输血量(257.1±557.0 vs 270.2±422.0,P=0.90)相仿,差异无统计学意义；术中肝门阻断率(10.5%(4)vs 50%(21))降低,且有统计学意义(P0.05)；术后肝功ALT峰值(145.7±138.4 vs 243.0±199.8)降低,ALB低值(35.3±3.7 vs 32.7±4.7)升高,术后进食时间(2.4±1.9 vs 3.5±1.8)缩短,术后住院天数(7.2±3.2 vs 10.0±3.5)减少,且均有统计学意义(P0.05)；术后3天平均腹腔引流量(147.0±155.6vs 127.7±170.4)、术后TBIL(23.2±10.8 vs 28.0±26.50)术后输血量(161.0±422.0vs 202.4±503.7)、术后并发症发生率(26.2% vs 23.8%)相仿,差异无统计学意义(P0.05)。腹腔镜下左半肝切除术手术时间较肝楔形切除和肝左外叶切除术手术时间明显延长(266.7±78.7 vs 205.7±56.2,P0.05；266.7±78.7 vs 200.6±56.9,P=0.06),随手术台次的增加,腹腔镜肝切除术手术时间逐渐缩短；腹腔镜肝切除术术中失血量与手术方式无关(P0.05),随手术台次的增加,腹腔镜肝切除术术中失血量逐渐减少。结论：手术经验是影响腹腔镜肝切除术术中操作的重要因素,随手术经验的积累,腹腔镜肝切除术手术时间和术中出血量逐渐减少。与开腹肝切除术相比,腹腔镜肝切除术手术创伤小、术后恢复快,但手术时间明显延长。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,腹腔镜下肝切除术是安全可行和值得推广的。
[Abstract]:Objective: to evaluate the safety and feasibility of laparoscopic hepatectomy (LHH) and open hepatectomy (OH) by comparing the operative and postoperative recovery of LHH and open hepatectomy. Materials and methods: from January 2012 to March 2015, the clinical data of 84 patients undergoing hepatectomy in two departments of organ transplantation outside bile duct of Shandong Provincial Hospital were collected. Laparoscopic hepatectomy was performed in 42 cases of LH group, open hepatectomy in 42 cases of liver lesions including benign diseases in 20 cases and malignant diseases in 22 cases. The ratio of male and female was 11: 10OH group, including 17 cases of benign diseases (17 cases), malignant diseases (17 cases) and malignant diseases (40. 5%). In 25 cases, the ratio of men to women was 12: 9.The two groups of patients had to be of age. The location and size of the lesion, the preoperative Child-Pugh grade of liver function and the operation mode were at the same level. All the patients were not complicated with serious organic diseases such as heart, lung and kidney. The operative time, blood loss, intraoperative blood transfusion, hepatic hilus occlusion rate and postoperative liver function of patients in LH group and OH group were retrospectively compared and analyzed, including the operation time, intraoperative blood loss, intraoperative blood transfusion, hepatic hilus occlusion rate and so on. After operation, the amount of blood transfusion, the volume of intraperitoneal drainage, the incidence of complications, the time of feeding after operation and the days of hospitalization after operation were all recovered. The advantages and disadvantages of early LH compared with OH were summarized. To analyze the relationship between the operation time and blood loss in LH group, the operation mode and the operating table (experience), and to establish the learning curve of laparoscopic hepatectomy. Results 84 patients underwent laparoscopic surgery, all of them recovered well, and no one died. The operative time in LH group was 225.6 卤83.3 vs 140.4 卤54.8, compared with that in OH group, and the operative time in LH group was significantly longer than that in OH group. The blood loss during operation was 292.4 卤333.3 vs 286.9 卤218.9P0.93) and the volume of blood transfusion was 257.1 卤557.0 vs 270.2 卤422.0P0.90). The peak value of ALT (145.7 卤138.4 vs 243.0 卤199.8) decreased the low value of ALB (35.3 卤3.7 vs 32.7 卤4.7), decreased the postoperative feeding time (2.4 卤1.9 vs 3.5 卤1.8), and decreased the postoperative hospitalization days (7.2 卤3.2 vs 10.0 卤3.5). The mean intraperitoneal drainage volume was 147.0 卤155.6 vs 127.7 卤170.4, TBIL(23.2 卤10.8 vs 28.0 卤26.50) the postoperative blood transfusion volume was 161.0 卤422.0 vs 202.4 卤503.7, and the incidence of postoperative complications was 26.2% vs 23.80.The mean postoperative intraperitoneal drainage volume was 147.0 卤155.6 vs 127.7 卤170.4, and the postoperative blood transfusion volume was 161.0 卤422.0 vs 202.4 卤503.7, respectively. The operative time of laparoscopic left hemihepatectomy was significantly longer than that of wedge-shaped hepatectomy and left lateral lobectomy (P 0.05266.7 卤78.7 vs 205.7 卤56.2P0.05266.7 卤78.7 vs 200.6 卤56.9). The amount of blood lost in laparoscopic hepatectomy is not related to the operative mode. With the increase of the operating table, the amount of blood loss in laparoscopic hepatectomy decreases gradually. Conclusion: the operative experience is an important factor affecting the operation of laparoscopic hepatectomy. With the accumulation of operative experience, the operative time and blood loss of laparoscopic hepatectomy gradually decreased. Compared with open hepatectomy, laparoscopic hepatectomy has less trauma and faster recovery after operation. But the operative time is obviously prolonged. Under the premise of strictly grasping the indication of operation and mastering the operative technique of endoscopic surgery, laparoscopic hepatectomy is safe, feasible and worth popularizing.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.3

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