腹腔镜与开腹肝Ⅶ、Ⅷ段肝切除术治疗肝肿瘤的近期疗效对比

Perioperative indicators of laparoscopic versus open radical resection for liver tumors in segment Ⅶ and Ⅷ

  • 摘要: 目的 比较腹腔镜与开腹肝Ⅶ、Ⅷ段肝肿瘤切除术的近期疗效。方法 回顾性分析2015年1月-2018年1月解放军总医院第一医学中心肝胆外科的肝Ⅶ、Ⅷ段肿瘤切除患者临床资料,腹腔镜肝切除(laparoscopic liver resection,LLR)组32例,年龄36 ~ 68岁,良性肿瘤18例,恶性肿瘤14例;开腹肝切除(open liver resection,OLR)组48例,年龄26 ~ 73岁,良性肿瘤14例,恶性肿瘤34例,比较两组的围术期及近期疗效。结果 腹腔镜组与开腹组在手术时间、肝门阻断时间、术中输血率、术后并发症方面无统计学差异(P>0.05),但腹腔镜组在术中出血量、术后肝功能指标、术后排气、术后拔管、术后住院时间、术后进食时间方面具有明显的优势(P<0.05)。随访结果显示,两组中恶性肿瘤患者术后1年复发率腔镜组(3.1%) vs 开腹组(0.4%)、生存率腔镜组(100%) vs 开腹组(100%)无统计学差异(P>0.05)。结论 腹腔镜与开腹肝Ⅶ、Ⅷ段肿瘤切除在恶性肿瘤根治性方面无差异,但是腹腔镜组具有微创、恢复快的优势,具有良好的安全性和根治性,可常规开展。

     

    Abstract: Objective To compare the perioperative indicators and short-term outcomes of laparoscopic versus open liver resection for tumors in segment Ⅶ and Ⅷ. Methods Clinical data about 32 patients (18 benign and 14 malignant tumors) aged 36-68 years who received laparoscopic liver resection (LLR group) and 48 patients (14 benign and 34 malignant tumors) aged 26-73 years who received open liver resection (OLR group) in our hospital from January 2015 to January 2018 were retrospectively collected and analyzed,and their perioperative and short-term outcomes were compared. Results There was no difference in operating time,time of Pringle maneuver,blood transfusion rate,and postoperative morbidity between the two groups (P>0.05).However,LLR group had obvious advantages in intraoperative blood loss (158.57 ml vs 428.70 ml),time to passing gas (2.55 days vs 3.14 days),time to removing the drainage (3.36 days vs 5.05 days),postoperative hospital stay (6.21 days vs 9.78 days),time to taking food (1.50 days vs 2.30 days),and liver functions than those in OLR group (all P<0.05).During the postoperative follow-up,there was no significant difference between patients with malignant tumor in the two groups in the postoperative recurrence rate (LLR:3.1%;OLR:0.4%) and the survival rate (100% in both groups) at 1 year after operation (P>0.05). Conclusion There is no difference in short-term outcomes between laparoscopic and open liver resection for the radical treatment of malignant tumors.However,laparoscopic liver resection has the advantages of minimally invasive and rapid recovery,which can be carried out routinely.

     

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