腹腔镜与开腹左肝切除术的前瞻性对照研究

Comparision of laparoscopic and open left Iobectomy ： a prospective controlled study

目的比较腹腔镜与开腹左肝切除术的疗效。方法前瞻性对照分析2010年5月至2011年6月哈尔滨医科大学附属第一医院92例行左肝切除术患者的临床资料。其中行腹腔镜下左肝切除术者42例（腹腔镜组），行开腹左肝切除术者50例（开腹组）。对比腹腔镜与开腹左肝切除术治疗左半肝肿瘤的优缺点。计量资料采用t检验，计数资料采用x2检验和Fisher确切概率法。结果腹腔镜组患者施行肝左外叶切除29例，左半肝切除13例；其中1例伤及肝中静脉中转开腹。开腹组患者施行肝左外叶部分切除33例，左半肝切除17例。腹腔镜组患者的手术切缘距肿瘤距离为（1．6±0．6）CIll，长于开腹组的（1．2±0．4）cm（t=3．81，P〈0．05）。但腹腔镜组患者的术中出血量为（158±89）ml，明显少于开腹组的（292±172）ml（t=4．56，P〈0．05）。腹腔镜组患者的术后镇痛时间、胃肠道功能恢复时间和住院时间分别为（1．2±0．3）d、（23±4）h、（7．5±2．8）d，明显短于开腹组的（2．0±1．1）d、（49±7）h、（11．3±4．2）d（t=4．57，21．31，5．00，P〈0．05）。腹腔镜组和开暖组患者术后第1天的AST、ALT较术前均有不同程度升高，但腹腔镜组升高的幅度较开腹组小（t=6．73，5．03，P〈0．05）；并且开腹组术后盯明显比术前延长（k2．32，P〈0．05）。腹腔镜组患者术后并发症发生率为7％（3／41），住院费用为（2．5±0．7）万元，均较开腹组的8％（4／50）和（2．6±0．6）万元低，但差异无统计学意义（t=0．74，P〉0．05）。开腹组患者中有1例术后因急性肝功能衰竭导致MODS死亡。结论腹腔镜左肝切除术成功率高，安全可行，与开腹手术比较具有手术创伤小、恢复快、总体疗效显著等优点。

Objective To compare the efficacy of laparoscopic and open left lobectomy. Methods The clinical data of 92 patients who received left lobectomy at the First Affiliated Hospital of Harbin Medical University from May 2010 to June 2011 were retrospectively analyzed. Of the 92 patients, 42 received laparoscopie left lobectomy （laparoscopie group） and 50 received open left lobectomy （open group）. The advantages and disadvantages between laparoscopic and open left lobectomy were compared. All data were analyzed using tile t test, chi-square test or by calculating the Fisher exact probability. Results Twenty-nine patients received left lateral lobectomy and 13 patients received left hemihepatectomy in the laparoscopie group. One patient was converted to the open group becaused of the injury of the middle hepatic vein. Thirty-three patients underwent left lateral lobectomy and 17 underwent left hemihepatectomy in the open group. The tumor-free resection margin of the laparoscopic group was （ 1.6±0.6） em, which was significantly longer than （ 1.2±0.4） cm of the open group （t =3.81, P 〈0.05 ）. The volume of operative blood loss of the laparoseopie group was （158 ±89）ml, which was significantly smaller than （292± 172） ml of the open group （ t = 4.56, P 〈 0.05 ）. The time of postoperative pain control, time to bowel function recovery and duration of hospital stay were （ 1.2±0.3 ） days, （23± 4） hours, （7.5 ±2.8 ）days in the laparoseopic group, which were significantly shorter than （2.0±1.1 ）days, （49 ±7 ）hours, （ 11.3 ±4.2）days in the open group, respectively （ t = 4. 57, 21.31, 5.00, P 〈 0.05 ）. The levels of aspartate arninotransferase （AST） and alanine aminotransferase （ALT） at postoperative （lay 1 were increased, while the increase of AST and ALT in the open group were greater than that in the laparoscopic group （ t = 6.73, 5.03, P 〈 0.05 ）. The postoperative prothrombin time in the open group was significantly longer than that before operation （ t = 2.32, P 〈 0.05 ）. The incidence of postoperative complications and total hospital costs were 7% （3/41） and （2.5±0.7） x 104 yuan in the laparoscopie group, which were lower than 8% （4/50） and （2.6 ＋0.6）×10^4 yuau in the open group, but no significant difference was observed （ t = 0.74, P 〉 0.05 ）. One patient in the open group died of multi-organ dysfunction syndrome caused by acute hepatic failure. Conclusion Laparoscopic left lobectomy is safe and effective, and it has the advantages of small trauma, quick recovery of patients and significant overall efficacy when compared with open left lobectomy.