腹腔镜肝切除术的临床应用研究

Study of clinical application of laparoscopic hepatectomy

目的探讨腹腔镜肝切除术的临床应用价值。方法选取41例行腹腔镜肝切除术肝癌患者作为研究组,同期44例行开腹肝切除术肝癌患者作为对照组,两组患者均由同一组医师实施手术,观察比较两组患者术中及术后相关指标、围手术期并发症发生情况及远期随访结果。结果研究组术中出血量、肛门排气时间、手术时间及住院时间均显著优于对照组,差异具有统计学意义(P<0.05)。研究组围手术期并发症发生率为24.4%,对照组围手术期并发症发生率为27.3%,两组围手术期并发症发生率比较差异无统计学意义(P>0.05)。两组随访6个月复发率、带瘤生存率、死亡率比较差异无统计学意义(χ~2=0.426、0.209、0.235,P>0.05)。两组随访12、24个月因随访例数少各项发生率无法进行统计学比较,结果为研究组复发率低于对照组,带瘤生存率高于对照组,死亡率低于对照组。结论相对于传统开腹手术,腹腔镜肝切除术具有创伤小,安全性高的优势,值得在临床中推广应用。

Objective To explore the clinical application of laparoscopic hepatectomy. Methods There were 41 liver cancer patients undergoing laparoscopic hepatectomy as research group, and concurrent 44 liver cancer patients undergoing open hepatectomy as control group. Both groups were operated by the same group of surgeons. The intraoperative and postoperative related indexes, perioperative complications and long-term followup results were observed and compared between the two groups. Results The research group had intraoperative bleeding volume, anal exhaust time, operation time and hospitalization time than the control group, and the difference was statistically significant（P〈0.05）. The research group had incidence of perioperative complications as 24.4%, which was 27.3% in the control group, and both groups had no statistically significant difference in incidence of perioperative complications（P〉0.05）. Both groups had no statistically significant difference in recurrence rate, tumor survival rate and mortality rate during 6 months of follow-up（χ^2=0.426, 0.209, 0.235, P〉0.05）. Both groups were followed up for 12 and 24 months, but the incidence of various statistical differences can not be compared because of the small cases of follow-up. The research group had lower recurrence rate than the control group, higher tumor survival rate and lower mortality rate than the control group. Conclusion Compared with traditional open surgery, laparoscopic hepatectomy has advantages of small trauma and high safety, and it is worthy of clinical promotion and application.