腹腔镜与开腹肝肿瘤切除术临床疗效的对比分析

发布时间：2018-06-24 22:40

本文选题：肝肿瘤 + 腹腔镜　；参考：《中国癌症杂志》2017年04期

【摘要】：背景与目的:随着腹腔镜技术在肝脏外科中的应用日渐广泛,腹腔镜肝切除的安全性和可行性逐步得到了认可,该研究旨在探讨腹腔镜肝肿瘤切除术与开腹肝肿瘤切除术的可行性与临床疗效。方法:回顾性分析复旦大学附属肿瘤医院2015年3月—2016年3月37例接受腹腔镜肝肿瘤切除术与74例接受传统开腹肝肿瘤切除术患者的临床资料,计量资料采用Wilcoxon秩和检验,统计值为Z,计数资料采用Fisher精确概率检验;分析手术时间、术中出血量、手术后胃肠道恢复时间、手术后引流管拔管时间、住院时间、术后并发症和住院费用等临床资料。腹腔镜组:男性20例,女性17例,年龄18~76岁(中位年龄55岁);开腹组:男性42例,女性32例,年龄26~74岁(中位年龄54岁)。切肝方式为超声刀+单极电凝,结合腹腔镜下切割缝合器。腹腔镜组的手术方式包括:局部切除13例;行肝段或肝叶解剖性切除24例。开腹组的手术方式包括:局部切除33例;行肝段或肝叶解剖性切除41例。结果:手术平均用时:腹腔镜组为149 min(40~204 min),开腹组为142 min(45~190 min)。术中出血量:腹腔镜组为220 m L(30~570 m L),开腹组为360 m L(90~970 m L)。平均住院时间:腹腔镜组为4.9 d(3.0~6.0 d),开腹组为6.8 d(5.0~9.0 d)。手术后胃肠道恢复平均时间:腹腔镜组为1.1 d,开腹组为2.3 d。手术后引流管拔管时间:腹腔镜组为3.1 d,开腹组为5.8 d。平均住院费用:腹腔镜组为38 760元,开腹组为39 145元。手术后并发症:腹腔镜组为8.1%(3/37),开腹组为9.5%(7/74)。结论:腹腔镜肝切除术是一种安全、有效、微创的手术,可安全用于局部、肝段及半肝切除术,值得推广使用。
[Abstract]:Background & objective: with the increasing application of laparoscopic technique in liver surgery, the safety and feasibility of laparoscopic hepatectomy have been gradually recognized. The purpose of this study was to investigate the feasibility and clinical efficacy of laparoscopic hepatectomy and open hepatectomy. Methods: the clinical data of 37 patients undergoing laparoscopic hepatectomy and 74 patients undergoing conventional open hepatectomy in the tumor Hospital of Fudan University from March 2015 to March 2016 were analyzed retrospectively. Wilcoxon rank sum test was used to measure the data. The statistical value was Z. Fisher accurate probability test was used to analyze the clinical data, such as operation time, intraoperative bleeding volume, postoperative gastrointestinal tract recovery time, postoperative drainage tube extubation time, hospitalization time, postoperative complications and hospitalization expenses. Laparoscopic group: male 20, female 17, age 1876 (median 55), open group: male 42, female 32, age 2674 (median 54). The mode of hepatectomy was ultrasonic knife unipolar electrocoagulation combined with laparoscopic suture. In the laparoscopic group, 13 cases underwent local resection and 24 cases underwent anatomical resection of liver segment or lobe. In the laparotomy group, 33 cases underwent local resection and 41 cases underwent anatomical resection of liver segments or lobes. Results: the mean time of operation was 149 min in the laparoscopic group (142 min (45 ~ 190 min).) in the open group of 40 ~ 204 min),. The intraoperative bleeding volume was 220ml (30570ml) in the laparoscopic group and 360 mL (90,970ml) in the laparotomy group. Mean hospitalization time: 4.9 days (3.0 d),) in laparoscopic group (6.8 d (5.0 d).) in laparotomy group) The average recovery time of gastrointestinal tract after operation was 1.1 days in laparoscopic group and 2.3 days in open group. The extubation time of drainage tube after operation was 3.1 days in the laparoscopic group and 5.8 days in the open group. The average hospitalization cost was 38,760 yuan in the laparoscopic group and 39,145 yuan in the open group. Postoperative complications were 8.1% (3 / 37) in laparoscopic group and 9.5% (7 / 74) in open group. Conclusion: laparoscopic hepatectomy is a safe, effective and minimally invasive operation, which can be safely used in local, segmental and hemihepatectomy.
【作者单位】：复旦大学附属肿瘤医院肝脏外科复旦大学上海医学院肿瘤学系;
【分类号】：R735.7

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