全腹腔镜肝切除临床研究

发布时间：2018-03-15 09:57

本文选题：肝切除术　切入点：腹腔镜手术　出处：《华中科技大学》2015年博士论文　论文类型：学位论文

【摘要】：目的：腹腔镜肝脏切除手术己开展20余年,对肝脏疾病的治疗起到很大的推动作用,取得了良好的效果,但仍然是技术难度高的手术,限制其发展的主要原因是尚未在技术上形成系统的方法,需要进一步探索并规范其流程。本课题目的在于探讨全腹腔镜下肝切除的应用技术,总结全腹腔镜肝切除手术技术要点和治疗效果。方法：回顾分析本组自2012年10月至2014年12月完成77例全腹腔镜肝切除术,分析其治疗效果,将其中40例全腹腔镜规则肝切除和同期、同组完成的70例开腹肝切除患者的临床资料和随访结果进行比较,分析两组手术时间、术中出血量、切口长度、术后肛门排气时间、引流管留置时间、并发症率、术后住院时间,肝癌切除术后复发率与生存率等指标。系统总结我科全腹腔镜肝切除术中各个环节的技术要点,形成规范的手术流程。结果：所有手术均获成功,两组患者均无围手术期死亡。77例全腹腔镜肝切除中良性病变45例,恶性肿瘤32例；局部不规则性切除37例,规则肝切除40例。开腹组中良性病变17例,肝癌53例。腹腔镜规则肝切除组(LH)与开腹组(OH)比较,一般情况、术中出血量、肝癌切除术后1、2年无瘤生存率和复发率差异无统计学意义(P0.05)。而手术时间、切口长度、术后肛门排气时间、引流管留置时间、并发症发生率、术后住院时间等与OH组比较差异有统计学意义(P0.05)。结论：腹腔镜肝切除可选择性应用于肝脏各个部位、各类病变的手术治疗。腹腔镜与开腹肝切除治疗比较具有切口美观、恢复快、术后并发症少等优点,手术时间较开腹时间长,术中出血量、肝癌切术后1、2年无瘤生存率和复发率相当。采用合理规范的手术方案将手术流程化,可使其更加容易推广。
[Abstract]:Objective: laparoscopic hepatectomy has been carried out for more than 20 years, which has played a great role in promoting the treatment of liver diseases and achieved good results, but it is still a technically difficult operation. The main reason for limiting its development is that there is no systematic method in technology, so it is necessary to further explore and standardize its process. The purpose of this study is to explore the application technology of total laparoscopic hepatectomy. To summarize the technical points and therapeutic effect of total laparoscopic hepatectomy. Methods: 77 cases of total laparoscopic hepatectomy from October 2012 to December 2014 were retrospectively analyzed. The clinical data and follow-up results of 70 patients with open hepatectomy in the same group were compared. The operative time, intraoperative blood loss, incision length, postoperative anal exhaust time, drainage tube indwelling time and complication rate were analyzed. The postoperative hospitalization time, recurrence rate and survival rate after hepatectomy were systematically summarized in all aspects of total laparoscopic hepatectomy in our department, and a standard procedure was formed. Results: all the operations were successful. There were no perioperative death in both groups. Among the 77 cases of total laparoscopic hepatectomy, 45 cases were benign lesions, 32 cases were malignant tumors, 37 cases were local irregular resection. There were 17 cases of benign lesions and 53 cases of liver cancer in the open group. LHs in the laparoscopic regular hepatectomy group were compared with those in the open group. There was no significant difference in 1- and 2-year tumor-free survival rate and recurrence rate after hepatectomy (P 0.05). However, the operative time, incision length, postoperative anal exhaust time, drainage tube indwelling time, and the incidence of complications were not statistically significant. The postoperative hospitalization time was significantly different from that of OH group (P 0.05). Conclusion: laparoscopic hepatectomy can be applied to various parts of the liver and surgical treatment of various pathological changes. Laparoscopic hepatectomy and open hepatectomy have the advantages of beautiful incision, quick recovery, less postoperative complications, and so on. The operative time is longer than that of open surgery, the amount of intraoperative bleeding, the 1 and 2 year tumor free survival rate and recurrence rate after hepatectomy are the same.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R735.7

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