摘要
目的对比分析腹腔镜微波消融术和腹腔镜肝切除术治疗肝血管瘤的临床疗效。方法回顾性分析2019年6月至2023年6月南京医科大学第一附属医院肝胆中心收治的98例肝血管瘤患者的临床资料, 其中男性20例、女性78例, 年龄范围24~69岁。按照手术方式分为腹腔镜微波消融术组(消融组)34例和腹腔镜肝切除术组(切除组)64例, 对比两组手术时间、术中出血量、病灶残留、术后住院时间、引流管拔除时间以及术后视觉模拟疼痛评分;术后第1天和第3天肝功能指标以及术后并发症等, 随访预后情况。结果微波组的手术时间和出血量分别为(90.6±21.8)min和(60.3±40.8)ml, 均少于切除组的(128.7±30.0)min和(165.8±212.7)ml,差异均有统计学意义(t=-6.54、-2.86, P<0.001、P=0.005)。消融组有5例(14.71%)病灶残留, 而切除组0例, 两组比较差异有统计学意义(χ^(2)=0.01, P=0.003)。消融组在住院时间、引流管拔除时间以及术后疼痛方面均优于切除组, 差异具有统计学意义(均P<0.05)。在术后第1天和第3天, 消融组的丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素以及直接胆红素水平均低于切除组, 差异具有统计学意义(均P<0.05)。消融组发生血红蛋白尿14例(41.2%)、腹腔出血2例(5.9%)、胆漏0例、胸腔积液6例(17.7%), 而切除组这些并发症分别为2例(3.1%)、18例(28.1%)、11例(17.2%)、32例(50.0%), 两组比较差异均有统计学意义(均P<0.05)。在预后方面两组各有1例复发(2.9%比1.6%), 差异无统计学意义(χ^(2)=1.00, P=0.653)。结论相较于腹腔镜肝切除术, 腹腔镜微波消融术在手术时间、术中出血量、住院时间、术后疼痛以及并发症等方面均具有明显优势。
Objective To compare and analyze the clinical efficacy of laparoscopic microwave ablation and laparoscopic hepatectomy in the treatment of hepatic hemangioma.Methods The clinical data of 98 patients with hepatic hemangioma admitted to the Hepatobiliary Center,the First Affiliated Hospital of Nanjing Medical University from June 2019 to June 2023 were retrospectively analyzed,including 20 males and 78 females,aged 24-69 years.According to the surgical method,they were divided into two groups:laparoscopic microwave ablation group(ablation group)with 34 cases,and laparoscopic hepatectomy group(resection group)with 64 cases.The differences in intraoperative and postoperative recovery related indicators,follow-up and prognosis between the two groups were compared and analyzed.Results The operative time and blood loss in the ablation group were(90.6±21.8)min and(60.3±40.8)ml,respectively,which were lower than those in the resection group(128.7±30.0)min and(165.8±212.7)ml,and the differences were statistically significant(t=-6.54,-2.86,P<0.001,P=0.005).There were 5 cases(14.71%)of residual lesions in the ablation group and none in the resection group,with a significant difference between the two groups(χ^(2)=0.01,P=0.003).The ablation group was superior to the resection group in hospital stay,drainage tube removal time and postoperative pain,with statistical significance(all P<0.05).On the 1st and 3rd day after surgery,the levels of alanine aminotransferase,aspartate aminotransferase,total bilirubin and direct bilirubin in ablation group were lower than those in resection group,and the differences were statistically significant(all P<0.05).In the ablation group,there were 14 cases of hemoglobinuria(41.2%),2 cases of abdominal hemorrhage(5.9%),0 cases of bile leakage and 6 cases of pleural effusion(17.7%),while in the resection group,these complications were 2 cases(3.1%),18 cases(28.1%),11 cases(17.2%)and 32 cases(50.0%),respectively,and there were statistical significance between the two groups(all P<0.05).In terms of prognosis,there was both one recurrence in each group(2.9%vs.1.6%),with no significant difference(χ^(2)=1.00,P=0.653).Conclusion Compared with laparoscopic hepatectomy,laparoscopic microwave ablation has obvious advantages in terms of operation time,intraoperative blood loss,hospital stay,postoperative pain and complications.
作者
丁文周
梁立涛
朱德明
孔连宝
周永平
Ding Wenzhou;Liang Litao;Zhu Deming;Kong Lianbao;Zhou Yongping(Hepatobiliary Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Hepatobiliary Surgery,Wuxi Second People's Hospital,Wuxi 214000,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2024年第11期819-823,共5页
Chinese Journal of Hepatobiliary Surgery
基金
无锡市科技局"太湖之光"科技攻关项目(Y20222002)
无锡市"双百"中青年医疗卫生拔尖人才(BJ023034)
南京医科大学第一附属医院青年科学基金培育计划(PY2022007)。
关键词
腹腔镜
微波消融术
腹腔镜肝切除术
肝血管瘤
Laparoscopes
Microwave ablation
Laparoscopic hepatectomy
Hepatic hemangioma
