摘要
目的探讨腹腔镜肝部分切除术的安全性、可行性。方法2002年11月至2010年12月我院行腹腔镜下肝部分切除术165例，与同期行传统开腹肝部分切除术170例进行比较。结果腹腔镜组159例腹腔镜肝部分切除术成功，6例因术中出血中转开腹肝部分切除术；开腹组170例均顺利完成肝部分切除术。腹腔镜肝切除术组住院时间（7．6±1．3d）显著低于开腹组（14．6±3．3d）（t=-12．657，P=0．00）。腔镜组总住院费用（31767．4±220．1元）显著低于开腹组（35127．3±392．2元）（t=-78．859，P=0．00）。腔镜组肝门阻断时间（20．6±8．5min）与开腹组（18．6±6．5min）无明显差异（t=2．108，P=0．068）。腔镜组术中出血量（420．8±76．5m1）与开腹组（395．9±96．1m1）无明显差异（t=2．157，P=0．063）。两组术后并发症无明显差异（t=2．011，P=0．156）。腹腔镜组手术时间（59．6±12．2min）显著长于开腹组（42．7±22．6min），（t=6．941，P=0．001）。结论对位于肝脏边缘、右肝表面或左肝外叶、左半肝、肝右叶下段的良恶性病灶，阻断肝门血流后行腹腔镜肝部分切除或行解剖性肝部分切除术是可行和安全的，且具有创伤小恢复快的特点。与传统开腹肝部分切除术相比除手术时间稍长外，阻断肝门时间、术中出血量、术后并发症及两年生存率无明显差异，而在住院时间和总住院费用方面开腹组明显高于腹腔镜组。
Objective To compare the feasibility and safety of laparoscopic versus open hepatectomy. Methods The data of 165 patients who underwent laparoscopic hepatectomy were compared with 170 patients who underwent open hepatectomy in our hospital from November 2002 to December 2010. Results Laparoscopic hepatectomy was successfully carried out in 159 patients and 6 patients were converted to open operation because of intra-operative hemorrhage. The 170 patients in the open operative group had open hepatectomy successfully carried out. The hospital stay and cost in the laparoscopic group （7.6±1.3 d, 31767.4±220.1 ￥） were less than the open operation group （14.6± 3.3 d, 35127.3±392.2￥ ） （t=-12.657, P〈0.001; t=-78.859, P〈0.001）. There was no significant difference in Pringle＇s manoeuvre time, blood loss and postoperative complications （20.6±8.5 vs. 18.6±6.5 min, t=2.108, P=0.068）, （420.8±76.5 vs. 395.9±96.1 ml, t=2.157, P=0. 063）, （0 vs. 4 cases, t=2. 011, P=0. 156）） between the 2 groups. The operative time in the laparoscopic group was significantly longer than the open group （59.64± 12.2 vs. 42.7±22.6 min） （t=6. 941, P〈0. 001）. Conclusions Laparoscopic hepatectomy is feasible and safe. It has the advantages of having less trauma and quicker recovery for tumors which were located superficially in the left liver and in the inferior part of the right liver. The operative time was longer than open hepatectomy, but there was no significant difference between the 2 groups in Pringle＇s manoeuvre time, blood loss and postoperative complications. The hospital stay and total hospital cost in the open operation group were higher than the laparoscopic hepatectomy group.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2012年第3期173-175,共3页
Chinese Journal of Hepatobiliary Surgery
基金
基金项目：广西科学研究与技术开发计划资助项目（桂科攻0672002-17）
广西区卫生厅课题（桂卫Z2009100）
