腹腔镜肝切除与开腹肝切除短期疗效的对比研究

发布时间：2018-04-18 19:16

本文选题：腹腔镜 + 肝切除术　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:随着科技的进步,外科领域手术器械和手术方式的不断革命和创新,使得微创外科取得的长足的进步。微创技术深入到了每一个外科领域,腹腔镜下肝切除术(Laparoscopic hepatoectomy,LH)也蓬勃发展起来。随着腹腔镜肝脏切除术的研究报道日益增加,国内外已经有大量关于腹腔镜肝切除术的安全性和有效性的文献研究。本文回顾性分析了我院行腹腔镜和开腹肝切除手术治疗的患者资料,旨在探讨腹腔镜肝切除在肝脏疾病的外科手术治疗中的临床价值。方法:回顾性分析2015年4月至2016年11月期间,符合排除纳入标准的在青岛大学附属医院肝胆胰外科住院行腹腔镜肝切除术的83例患者(其中肝肿瘤患者61例,肝胆管结石患者22例),及同期行开腹肝切除术的82例患者(其中肝肿瘤患者45例,肝胆管结石患者37例),对施行腹腔镜手术和开腹手术的肝肿瘤患者与肝胆管结石患者分别比较,分析比较腹腔镜肝切除和开腹肝切除治疗肝脏疾病的疗效。根据其手术方式分为LH(Laparoscopic hepatectomy)组及OH(Open hepatectomy)组。分别比较肝肿瘤患者和肝胆管结石患者的手术时间、术中出血量,术中输血患者比例、术中行肝门阻断患者比例、术中住院天数、术后第1d、3d、5d、7d肝功能恢复情况以及术后并发症的情况,对比腹腔镜肝切除术与开腹肝切除术的短期临床评价指标,评估腹腔镜手术治疗肝脏肿瘤、肝胆管结石的近期疗效和安全性。所有数据应用SPSS 19.0软件进行统计学分析,P0.05表示差异有显著性。结果:所有手术均顺利完成,围手术期无死亡病例,通过分析腹腔镜肝切除术患者组(LH组)与开腹肝切除术患者组(OH组)的统计资料,发现无论是肝肿瘤患者还是肝胆管结石患者,术前在性别比例、年龄、病变位置、病变大小、Child A级患者所占百分比、术前肝功能指标等方面没有明显差别(P0.05);而术后统计资料的比较中,LH组和OH组在手术时间、患者术中输血比例、术中行肝门阻断者比例方面无明显差异(P0.05),在术中出血量、术后住院日、术后肝功能恢复速度等方面均优于OH组,差异具有统计学意义(P0.05)。结论:同开腹手术相比,腹腔镜肝切除术具有手术创伤轻,术后恢复快、住院时间缩短等诸多优点,对于治疗肝脏良恶性疾病是安全可行的。
[Abstract]:Objective: with the development of science and technology, the continuous revolution and innovation of surgical instruments and surgical methods in the field of surgery make great progress in minimally invasive surgery.Minimally invasive techniques have penetrated into every field of surgery, and laparoscopic hepatectomy has flourished.With the increasing number of studies on laparoscopic hepatectomy, there have been a lot of literatures on the safety and effectiveness of laparoscopic hepatectomy at home and abroad.The clinical data of patients undergoing laparoscopic and open hepatectomy in our hospital were retrospectively analyzed in order to explore the clinical value of laparoscopic hepatectomy in the surgical treatment of liver diseases.Methods: from April 2015 to November 2016, 83 patients (61 patients with liver tumor) who were hospitalized in the Department of Hepatobiliary and Pancreatic surgery, Qingdao University affiliated Hospital, were analyzed retrospectively.There were 22 patients with hepatolithiasis and 82 patients with hepatectomy at the same time (including 45 patients with liver tumor).A total of 37 patients with hepatolithiasis underwent laparoscopic and open hepatectomy were compared with those with hepatolithiasis. The efficacy of laparoscopic hepatectomy and open hepatectomy in the treatment of liver diseases was analyzed and compared.According to its operation mode, it was divided into LH(Laparoscopic group and OH(Open group.The operative time, intraoperative blood loss, blood transfusion, hepatic hilus occlusion and hospitalization were compared between patients with hepatic tumor and patients with hepatolithiasis.The recovery of liver function and postoperative complications were observed on the 1st day, 3rd day and 5th day after operation. The short-term clinical evaluation indexes of laparoscopic hepatectomy and open hepatectomy were compared to evaluate the short-term efficacy and safety of laparoscopic hepatectomy in the treatment of liver tumors and hepatolithiasis.All the data were statistically analyzed by SPSS 19.0 software.Results: all the operations were completed successfully. There were no death cases in perioperative period. The statistical data of the patients with laparoscopic hepatectomy (LH group) and open hepatectomy group (OH group) were analyzed.It was found that the percentage of Child-A patients with liver tumor or hepatolithiasis before operation in sex ratio, age, location of lesion and size of lesion were found.There was no significant difference in preoperative liver function indexes between LH group and OH group in the time of operation, the proportion of blood transfusion during operation, and the proportion of patients undergoing hepatic hilar occlusion, but there was no significant difference in blood loss during operation between LH group and OH group.The days of hospitalization and the recovery rate of postoperative liver function were better than those of OH group (P 0.05).Conclusion: compared with open surgery, laparoscopic hepatectomy is safe and feasible for the treatment of benign and malignant liver diseases.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;R657.3

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