腹腔镜肝细胞癌切除的研究

发布时间：2018-09-06 07:04

【摘要】：简介:腹腔镜微创手术是二十一世纪外科发展的一大趋势。它的特点是疤痕小,恢复快,从而越来越受到病人青睐。然而,由于肝脏解剖及生理的特殊性和技术器械的限制,腹腔镜下肝脏切除术的开展仍然存在许多困难:肝脏切除时出血的控制,深部肿瘤的定位,手术仪器的操作以及空间和视野的限制等等。:随着腹腔镜技术的逐步发展与成熟,腹腔镜肝切除术已成为一个相对安全的方法。该技术首次应用于肝脏良性肿瘤的治疗,随后也在肝脏恶性肿瘤的治疗中逐渐开展。本文就腹腔镜肝切除术和开放性肝癌切除术的优点和缺点进行了比较和分析。方法:2011年到2015年,选取14篇相关文献对HCC患者进行评价。(1)使用Cochrane RevMan软件,用forest plot来比较腹腔镜肝切除术(LH)与开腹肝切除术(OH)的术后并发症。(2)应用PRISM软件,对两组患者的平均围手术期出血量、手术时间及住院时间进行了比较。结果:(1)与OH相比,LH并发症发生率较低。Oddratio = 0.39.Forest plot结果也显示OH存在较高的并发症,Odd ratio = 0.61;χ2 =16.27,df = 9(p = 0.06,具有统计学意义),12 = 45%。Test for overall effect,Z= 7.10(2)LH患者住院时间较短,平均失血量也较低。但是,平均手术时间LH高于OH。经统计学检验,LH与OH的5年生存率和复发率之间的差异无统计学意义。结论:腹腔镜肝切除术具有较多优势:并发症严重程度较低、住院时间和出血量较少,创伤小。在新技术的发展与手术经验的累积下,腹腔镜肝切除术的手术时间也将会逐渐减少,使其成为安全可行且广泛应用的肝癌治疗方法。
[Abstract]:Summary: laparoscopic minimally invasive surgery is a major trend of surgical development in the 21 century. It is characterized by small scars, quick recovery, and thus more and more favored by patients. However, due to the particularity of liver anatomy and physiology and the limitation of technical instruments, there are still many difficulties in the development of laparoscopic hepatectomy: the control of bleeding during hepatectomy, the localization of deep tumors, With the development and maturity of laparoscopic technique, laparoscopic hepatectomy has become a relatively safe method. This technique was first used in the treatment of benign liver tumors, and then gradually developed in the treatment of liver malignant tumors. The advantages and disadvantages of laparoscopic hepatectomy and open hepatectomy were compared and analyzed. Methods: from 2011 to 2015, 14 articles were selected to evaluate the patients with HCC. (1) using Cochrane RevMan software, forest plot was used to compare the postoperative complications between laparoscopic hepatectomy (LH) and open hepatectomy (OH). (2) PRISM software was used. The mean perioperative bleeding, operative time and hospital stay were compared between the two groups. Results: (1) compared with OH, the incidence of LH complications was lower. Oddrratio = 0.39.Forest plot. The results also showed that OH had higher complications: Odd ratio = 0. 61, 蠂 2 + 16. 27 d f = 9 (p = 0. 06, with statistical significance) 12 = 45%.Test for overall effect,Z= 7. 10 (2) LH patients had shorter hospitalization time and lower average blood loss. However, the average operative time of LH was higher than that of OH.. There was no significant difference in 5-year survival rate and recurrence rate between LH and OH. Conclusion: laparoscopic hepatectomy has many advantages: the severity of complications is low, the length of hospital stay and the amount of bleeding are less, and the trauma is small. With the development of new technology and the accumulation of surgical experience, the operative time of laparoscopic hepatectomy will be gradually reduced, making it a safe and feasible and widely used method for the treatment of liver cancer.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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