腹腔镜与开腹手术治疗肝囊肿32例临床分析

Clinical study on laparoscopic and open surgery in hepatic cyst with a report of 32 cases

目的比较腹腔镜与开腹手术治疗肝囊肿的疗效与安全性。方法回顾性分析我院2008年1月至2011年12月行手术治疗的32例肝囊肿患者临床资料,其中运用腹腔镜手术治疗(腹腔镜组)19例,开腹手术治疗(开腹组)13例。比较两组的手术时间、术中出血量、术后并发症发生率、胃肠功能恢复时间、住院时间、住院费用、术后肝功能及肝囊肿复发率差异。结果与开腹组相比,腹腔镜组术中出血量少(P=0.014)、胃肠功能恢复时间短(P=0.002)、住院时间短(P=0.036);而手术时间、术后并发症发生率、术后丙氨酸氨基转移酶与总胆红素以及住院费用均无明显差别。术后27例获得随访,随访率84.4%(27/32),随访2～38个月,平均16个月,两种手术方式的肝囊肿复发率无明显差异。结论腹腔镜手术治疗肝囊肿创伤小,术后患者恢复快,住院时间短,应成为肝囊肿的首选治疗方法。

Objective To compare the efficacy and safety of laparoscopic and open surgery for hepatic cyst. Methods The clinical data of 32 hepatic cyst patients who underwent surgery in our hospital from January 2008 to December 2011 were retrospectively analyzed. Laparoscopic surgery （laparoscopy group） was used for 19 patients and open surgery （laparotomy group） was used for 13 pa- tients. The operation time, operative blood loss, postoperative complications, time of gastrointestinal function recovery, hospital stay, cost of hospitalization, postoperative liver function and hepatic cyst recurrence rates were analyzed. Results Compared with laparoto- my group, laparoscopy group had less operative blood loss （ P = 0. 014 ）, shorter time of gastrointestinal function recovery （ P = 0. 002 ）, shorter hospital stay （P = 0. 036）. No significant differences were found for operation time, postoperative complications, lev- els of postoperative alanine aminotransferase and postoperative total bilirubin, and cost of hospitalization. Among the cases, 27 patients （27/32, 84. 4% ） received a mean of 16-month follow-up （ranged from 2 to 38 months）. The cyst recurrence rates had no significant difference in two groups. Conclusion Laparoscopic surgery in treatment of hepatic cyst is minimally invasive with faster recovery and shorter hospital stay. The procedure should be the first choice for hepatic cyst.