腹腔镜肝左外叶切除术初学者体会及疗效分析

Experience and clinical effect of beginners on laparoscopic left lateral hepatectomy

目的总结初期开展腹腔镜肝左外叶切除术的经验及疗效,为腹腔镜肝切除初学者提供参考。方法回顾性分析单一术者初期开展的23例腹腔镜肝左外叶切除术(Laparoscopic hepatectomy,LH)的临床资料(LH组),选取同期开腹肝左外叶切除(Open hepatectomy,OH)26例作为对照(OH组),观察并比较两组的手术时间、出血量、术后肝功能恢复情况、并发症和术后平均住院时间。结果 LH组手术时间明显长于OH组(P<0.05),术中出血量明显多于OH组(P<0.05)。LH组和OH组术后第5天ALT、AST、TBIL和术后住院天数比较差异无统计学意义(P>0.05)。LH组术后发生胆漏3例、肝断面脓肿1例、肺部感染2例。OH组术后发生胆漏1例、切口感染2例、肺部感染2例。结论初学者开展腹腔镜肝左外叶切除术可逐步掌握实施,能取得与传统开腹肝左外叶切除相似的临床疗效。

Objective To provide reference for beginners by summarizing expereince and analyzing the clinical effect in laparoscopic left lateral hepatectomy. Methods A total of 23 patients who underwent laparoscopic left lateral hepatectomy by a single surgeon at the early time were enrolled in the study as LH group. 26 patients who underwent open left lateral hepatectomy during this period were selected as OH group. The operative time, intraoperative blood loss, postoperative complications, duration of hospitalization and postoperative ALT,AST and TBIL levels were compared. Results The operative time in the LH group was longer than the OH group(P<0.05). The intraoperative blood loss in the LH group was significantly more than the OH group(P<0.05). The levels of ALT, AST and TBIL on the fifth day after surgery and the duration of hopitalization were similar between the two groups(P>0.05). In LH group, 3 cases got developed bile leakage, 1 case got abscess adjacent to liver and 2 cases got pulmonary infection. While 1 case got bile leakage, 2 cases got incision infections and 2 cases got pulmonary infections in the OH group. Conclusion Laparoscopic left lateral hepatectomy is a safe and feasible procedure for beginners, which is proved to have the same clinical effect compared with open left lateral hepatectomy.