腹腔镜肝切除与开腹肝切除在肝脏肿瘤治疗中的临床研究

发布时间：2018-04-24 12:00

本文选题：腹腔镜肝切除 + 开腹肝切除　；参考：《泸州医学院》2015年硕士论文

【摘要】：目的：本文通过对腹腔镜肝切除与开腹肝切除术就手术及其术后疗效作一比较,进而肯定腹腔镜肝切除术对于治疗肝脏肿瘤的临床应用价值,用以评价腹腔镜肝切除的安全性及可行性,及其与开腹肝切除术相比所体现出的优越性与不足。方法：根据本研究中病例选择的纳入标准和排除标准,收集了宜宾市第一人民医院普外科自2010年1月～2012年1月的45例患者的临床资料。根据手术方式分为腹腔镜(LH, Laparoscopic hepatectomy)组和开腹(OH, Open hepatectomy)组。观察和比较两组患者的一般资料、手术时间、术中出血量、输血情况、肝门阻断与否、术后住院天数、术后镇痛药物的使用、术后携带胃管时间、术后携带引流管的时间；术后并发症；术后生存状况等指标。采用定期的门诊随访、电话随访或医护人员上门随访相结合的随访方式,建立统一、齐全的数据库资料,详细登记患者术后的恢复情况,以及术后并发症的发生情况。结果：腹腔镜组与开腹组在年龄、性别、肝功能分级、根据肿瘤的位置所选择的切除方式、病灶直径、病变分类、病变部位等临床病理学特征上差异无显著性(P值0.05)。腹腔镜组手术时间为189.35±13.94(min)、术中出血量为517.83±69.74(m1)、输血2例、阻断肝门血流4例；开腹组手术时间为164.23±20.90(min)、术中出血量为612.27±41.85(m1)、输血8例、阻断肝门血流10例。腹腔镜组与开腹组手术时间比较P值0.05,两组在手术时间方面无明显统计学差异；腹腔镜组与开腹组在术中出血、是否输血、是否阻断肝门方面比较皆P值0.05,差异具有统计学意义。腹腔镜组与开腹组在术后并发症中腹腔出血、肺部感染、胆漏、切口感染、腹腔积液、腹腔感染、胸腔积液等比较差异无统计学意义(P0.05)。腹腔镜组与开腹组在术后并发症总例数比较差异亦无统计学意义(X2=1.171,P=0.279)。腹腔镜组存活中位数为26.70±0.92(月),开腹组存活中位数为24.33±0.83(月),两组比较无显著性差异(P=0.857),腹腔镜肝切除与开腹肝切除术对术后生存无显著差别。结论：腹腔镜及开腹肝切除术对于治疗肝脏良恶性肿瘤均具有良好的效果,具有可行性,但腹腔镜肝切除术具有腹壁切口小、术后使用镇痛药物少、术后恢复快、住院时间短等优越性。因此,经过完善的术前评估、病例选择合适的前提下,肝脏良恶性肿瘤患者行腹腔镜肝切除术是微创、安全的、可行的,并在术后恢复方面腹腔镜肝切除较开腹肝切除术有其独特的优势。
[Abstract]:Objective: to evaluate the clinical value of laparoscopic hepatectomy (LC) in the treatment of liver tumors by comparing the results of laparoscopic hepatectomy and open hepatectomy. To evaluate the safety and feasibility of laparoscopic hepatectomy and its advantages and disadvantages compared with open hepatectomy. Methods: according to the inclusion and exclusion criteria of case selection in this study, the clinical data of 45 patients in general surgery of Yibin first people's Hospital from January 2010 to January 2012 were collected. According to the operation mode, the patients were divided into two groups: laparoscopy group (LH group), Laparoscopic group and Open group (OH group). The general data, operative time, intraoperative blood loss, blood transfusion, hepatic hilus occlusion, postoperative hospitalization days, postoperative analgesic drug use, postoperative gastric tube carrying time and postoperative drainage tube were observed and compared between the two groups. Postoperative complications, postoperative survival status and other indicators. By means of regular out-patient follow-up, telephone follow-up or in-door follow-up of medical staff, a unified and complete database was established to record the recovery of patients after operation and the occurrence of postoperative complications. Results: there was no significant difference in age, sex, liver function grade, tumor location, lesion diameter, lesion classification, pathological location and other clinicopathological features between laparoscopy group and laparotomy group (P = 0.05). In the laparoscopy group, the operative time was 189.35 卤13.94 min, the intraoperative blood loss was 517.83 卤69.74 m ~ (-1), blood transfusion was performed in 2 cases, and the hepatic portal blood flow was blocked in 4 cases, the operative time in the open group was 164.23 卤20.90 min, the intraoperative bleeding volume was 612.27 卤41.85 m ~ (-1), the blood transfusion was in 8 cases, and the hepatic portal blood flow was blocked in 10 cases. There was no significant difference in the operative time between the laparoscopic group and the laparotomy group, the bleeding and blood transfusion were observed in the laparoscopic group and the open group. There was a significant difference in P value of 0.05 for hepatic hilus occlusion. There was no significant difference between laparoscopy group and laparotomy group in abdominal cavity hemorrhage, pulmonary infection, bile leakage, incision infection, peritoneal effusion, abdominal infection, pleural effusion and so on. There was no significant difference in the total postoperative complications between the laparoscopic group and the open group. The median survival of laparoscopy group was 26.70 卤0.92 (month), and that of open group was 24.33 卤0.83. There was no significant difference between the two groups. There was no significant difference between laparoscopic hepatectomy and open hepatectomy in postoperative survival. Conclusion: both laparoscopic and open hepatectomy are effective and feasible in the treatment of benign and malignant liver tumors. However, laparoscopic hepatectomy has small abdominal incision, less analgesic drugs after operation, and quick recovery after operation. The advantage of short hospital stay. Therefore, laparoscopic hepatectomy is minimally invasive, safe and feasible for patients with benign and malignant tumors of the liver. Laparoscopic hepatectomy has a unique advantage over open hepatectomy in postoperative recovery.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.7

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