腹腔镜肝肿瘤切除术临床观察

Clinical Observation of Liver Neoplasms Resection under Laparoscopes

目的探讨腹腔镜肝肿瘤切除术治疗肝肿瘤的有效性和安全性。方法回顾性分析2013年1月—2015年1月收治的肝肿瘤55例。将采用腹腔镜手术的28例作为观察组,行开腹肝切除术的27例作为对照组。观察两组手术情况,包括手术时间、术中出血量、腹腔引流时间和住院时间,并对两组术前1 d和术后1、3 d肝功能和凝血指标进行比较。统计两组并发症、复发转移发生情况和1年生存情况。结果观察组术中出血量少于对照组,腹腔引流时间和术后住院时间均短于对照组(P<0.05)。两组手术时间比较差异无统计学意义(P>0.05)。两组术后1 d和3 d丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)高于术前1 d(P<0.05)。术后1 d和3 d观察组ALT、AST低于对照组(P<0.05)。两组并发症、术后复发转移发生率及生存率比较差异均无统计学意义(P>0.05)。结论与开腹肝切除术相比,腹腔镜肝切除术创伤小,有利于肝功能的早期恢复,未增加并发症及术后转移复发风险,可以用于肝肿瘤切除。

Objective To investigate effect and safety of liver neoplasms resection under laparoscopes. Methods Clinical data of 55 patients with liver neoplasma admitted during January 2013 and January 2015 was retrospectively analyzed,and then the patients were divided into 28 patients with hepatectomy under laparoscopes（ observation group） and27 patients with laparotomy（ control group）. In two groups,operative time,intraoperative volume of blood loss,duration of coeliac drainage and hospital stay were observed,and liver function and blood clotting index on preoperative 1 d and postoperative 1 and 3 d were compared,and then incidence rate of complications,recurrence,metastasis and 1-year survival rate were recorded. Results In observation group,intraoperative volume of blood loss was less,and duration of coeliac drainage and hospital stay were shorter than those in control group（ P〈0. 05）. There was no significant difference in operative time between two groups（ P〉0. 05）. Levels of alanine transarninase（ ALT）,aspartate aminotransferase（ AST） and total bilirubin（ TBIL） on postoperative 1 and 3 d were significant higher compared with those on preoperative 1 d（ P〈0. 05）. ALT and AST levels on postoperative 1 and 3 d in observation group were lower than those in control group（ P〈0. 05）,but there were no significant differences in incidence rate of complications,postoperative recurrence and metastasis rates and survival rate in two groups（ P〈0. 05）. Conclusion Compared with those by laparotomy,hepatectomy under laparoscopes has minimal injury and better early recovery of liver function without increasing risk of complications and postoperative risk of metastasis and recurrent.