不同阶段腹腔镜与开放肝脏部分切除术围术期疗效比较

Comparison of perioperative effects of laparoscopic liver partial resection and open liver partial resection at different stages

目的比较不同阶段腹腔镜与开放肝脏部分切除术治疗肝脏疾病的围术期临床疗效及安全性。方法回顾性分析2014年至2017年郑州大学人民医院收治的行肝脏部分切除手术患者77例,分为腹腔镜组及开放手术组。腹腔镜组中2014年1月至2015年12月收治的患者为学习期,2016年1月至2017年12月收治的患者为熟练期。比较围术期患者手术时间、术中出血量、病灶直径、术后肝功能、术后禁食时间、住院天数及术后并发症发生情况。结果学习期腹腔镜组切除病灶部位多位于肝脏边缘肝(叶)段表浅部位(Ⅱ、Ⅲ、Ⅴ、Ⅵ段)内,熟练期腹腔镜组切除病灶部位可位于肝脏各个部位。学习期腹腔镜组术后住院时间[(6.6±2.5)d]短于开放手术组[(10.7±2.3)d],差异有统计学意义(P<0.01)。学习期腹腔镜组与开放手术组相比,手术时间、术中出血量、病灶直径、术后肝功能指标、术后禁食时间、术后并发症发生情况差异未见统计学意义(P>0.05)。熟练期腹腔镜组手术时间[(104.6±32.4)min]短于开放手术组[(140.9±32.5)min],术中出血量[(139.3±43.5)ml]少于开放手术组[(175.6±56.3)ml],术后禁食时间[(1.5±0.6)d]短于开放手术组[(2.0±0.5)d],术后住院时间[(6.5±2.1)d]短于开放手术组[(10.8±1.8)d],差异有统计学意义(P<0.05)。熟练期腹腔镜组与开放手术组相比,病灶直径、术后肝功能指标、术后并发症发生情况比较差异未见统计学意义(P>0.05)。结论郑州大学人民医院腹腔镜技术经过曲线学习期后,手术适应证逐步扩大,腹腔镜肝脏部分切除术患者手术时间明显缩短、术中出血量减少、术后恢复快,其安全性及有效性逐渐突出。

Objective To compare the clinical effects of laparoscopic liver partial resection and open hepatectomy at different stages on liver disease during perioperative period and evaluate its safety.Methods Sevnty-seven patients with partial hepatectomy admitted to People’s Hospital of Zhengzhou University from 2014 to 2017 were retrospectively analyzed.According to the operation method,the patients were divided into laparoscopic group and open surgery group.In laparoscopic group,the study period was from January 2014 to December 2015,and the proficiency period was from January 2016 to December 2017.The operation time,intraoperative bleeding volume,leison diameter,liver function,fasting time,hospital stay and complications were compared.Results In learning laparoscopic group,most of the resected lesions were located in superficial part of the hepatic marginal segment(Ⅱ、Ⅲ、Ⅴ、Ⅵsegment);and in skilled laparoscopic group,the resected lesions could be located in all parts of the liver.The length of hospitalization in learning laparoscopic group[(6.6±2.5)d]was shorter than that in open surgery group[(10.7±2.3)d],and the difference was significant(P<0.01).There were no significant differences in operation time,intraoperative bleeding volume,lesion diameter,liver function index,fasting time or complications between open surgery group and learning laparoscopic group(P>0.05).The operation time of skilled laparoscopic group[(104.6±32.4)min]was shorter than that of open surgery group[(140.9±32.5)min],the intraoperative bleeding volume[(139.3±43.5)ml]was less than that of open surgery group[(175.6±56.3)ml],the fasting time[(1.5±0.6)d]was shorter than that of open surgery group[(2.0±0.5)d],and the hospitalization time[(6.5±2.1)d]was shorter than that of open surgery group[(10.8±1.8)d],and the differences were significant(P<0.05).There was no significant difference in the diameter of lesions,liver function or complications after surgery between skilled laparoscopy group and open surgery group(P>0.05).Conclusions After the curve learning period,the indications of laparoscopic surgery in People’s Hospital of Zhengzhou University are gradually expanded.The operation time of laparoscopic partial hepatectomy is significantly shortened,the amount of bleeding during the operation is reduced,and the recovery is fast.The safety and effectiveness of laparoscopic partial hepatectomy is gradually prominent.