腹腔镜肝切除术45例临床疗效分析

Analysis of Clinical Curative Effect of 45 Cases Treated with Laparoscopic Liver Resection

目的探讨腹腔镜肝切除术的可行性、安全性及微创性。方法回顾性分析2014年10月—2016年10月该院肝胆胰外科完成的45例腹腔镜肝切除术(LH组)与45例开腹肝切除术(OH组)患者的临床资料,对比两组手术时间、出血量、并发症发生率、术后镇痛药物使用率、禁食时间、住院时间及肝功能指标。结果两组患者在手术时间、出血量、并发症发生率3个方面,差异无统计学意义(P>0.05);LH组术后镇痛药物使用率、禁食时间、住院时间及术后第1天丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)均明显低于OH组[17.78%vs 44.44%,(1.4±0.5)d vs(2.6±0.8)d,(4.6±2.1)d vs(8.5±1.8)d,(144.7±39.2)U/L vs(217.4±43.3)U/L,(44.0±9.8)μmol/L vs(61.1±10.5)μmol/L],LH组术后第1天白蛋白(ALB)明显高于OH组(37.2±4.2)g/L vs(31.6±4.7)g/L,差异有统计学意义(P<0.05)。结论与开腹肝切除术相比,腹腔镜肝切除术同样安全可行,而且具有创伤小、术后疼痛轻、恢复快、对肝功能影响小等微创优势,值得在临床中推广使用。

Objective To study the feasibility,safety and invasiveness of laparoscopic liver resection.Methods 45 cases of patients with laparoscopic liver resection and 45 cases with open hepatectomy in our hospital from October 2014 to October2016 were selected and the operation time,bleeding amount,incidence rate of complications,utilization rate of postoperative analgesic drugs,fasting time,length of stay and liver function indexes were compared between the two groups.Results There were no obvious difference in the operation time,bleeding amount and incidence rate of complications,and the differences had no statistical significance（P〉0.05）,the use rate of postoperative analgesic drugs,fasting time,length of stay,ALT and TBIL in 1d after operation in the LH group were obviously lower than those in the OH group,[（17.78% vs44.44%,（1.4±0.5）dvs（2.6±0.8）d,（4.6±2.1）d vs（8.5 ±1.8）d,（144.7 ±39.2）U/L vs（217.4 ±43.3）U/L,（44.0 ±9.8）μmol/Lvs（61.1±10.5）μmol/L],and the ALB in 1d after operation in the LH group was obviously higher than that in the OH group,[（37.2±4.2）g/L vs（31.6±4.7）g/L],and the difference had statistical significance（P〈0.05）.Conclusion The laparoscopic liver resection also has the advantages of small wound,less postoperative pains,rapid recovery and small effect on liver function compared with the open hepatectomy,which is worth clinical promotion and application.