完全腹腔镜与开放肝切除治疗肝恶性肿瘤短期疗效比较

Short-term outcomes of pure laparoscopic versus open hepatectomy for liver malignant tumors

目的:探讨分析完全腹腔镜与开放肝恶性肿瘤肝切除短期临床疗效。方法:回顾性分析2016年1月-2018年12月在新疆维吾尔自治区人民医院肝胆外科住院并接受择期完全腹腔镜肝切除术的肝恶性肿瘤患者50例(LH组),根据年龄、性别匹配选择开放肝切除术的肝恶性肿瘤患者50例(OH组)。对比两组患者术前基本资料、术中情况、术后1月内并发症发生率及肿瘤学结果。结果:两组患者平均年龄、性别、术前Child分级、肝炎病史、肝硬化病史、肝癌类型、是否行解剖性肝切除、肿瘤部位分布、肿瘤平均最大直径、平均第一肝门阻断时间、手术切缘阳性率、微血管侵犯比例等差异均无统计学意义(P>0.05)。两组手术方式及肝切除范围差异无统计学意义(P>0.05)。LH组平均手术时间较OH组长,差异有统计学意义(P<0.05)。两组患者术中出血量、输血率差异无统计学意义(P>0.05)。两组胃肠道功能恢复平均时间、腹腔引流管拔出平均时间、住院时间差异均有统计学意义(P<0.05)。LH组与OH组Clavien-Dindo分级Ⅰ~Ⅱ级并发症发生率分别为10%与24%,无Ⅲ~Ⅳ级并发症发生,差异均无统计学意义(P>0.05),经保守治疗后均顺利恢复出院。结论:腹腔镜肝切除术对机体影响小、术后恢复快,合理选择肝肿瘤患者,可以获得与开放肝切除相似的近期疗效。

Objective:To investigate the short-term efficacy of pure laparoscopic hepatectomy(LH)versus open hepatectomy(OH)for the treatment of liver malignant tumors.Methods:The patients with liver malignant tumors who underwent elective hepatectomy between January 2016 to December 2018 in department of hepatobiliary surgery of People’s Hospital of Xinjiang Uygur Autonomous Region were retrospectively analyzed.50 patients who undergoing LH were enrolled to this study.Meanwhile,according to age and sex,50 patients who undergoing OH were matched,and conduct comparative analysis of clinical data between two groups.To compare and analyze the preoperative baseline information,intraoperative findings,postoperative complication rate within one-month,oncological results between two groups,to confirm if LH is superior to OH.Results:There were no significant differences in average age,gender,preoperative child score classification,history of hepatitis,presence of liver cirrhosis,pathological type of liver malignant tumor,presence of anatomical liver resection,tumor location distribution,maximum diameter of tumor,average time of hepatic inflow occlusion,positive rate of surgical margin,presence rate of microvascular inclusion between two groups(P>0.05).There is no significant difference in style of operation and hepatectomy scope between two groups(P>0.05).Average operation time of patients in LH group was longer than those in OH group(P<0.05).The difference of volume of intraoperative blood loss,blood transfusion rate between two groups were not statistically significant(P>0.05).Average postoperative feeding time,average peritoneal drainage tube removal time,hospital stay were(2.00 and 3.50)days,(5 and 9)days,(18.44±5.97 and 22.24±8.21)days,(210 and 240)min,(13 and 25),(28%and 48%),there was significant difference between the two groups(P<0.05).Presence rate of postoperative complications(Clavien-Dindo grades I-II)in LH groups and OH groups were(10%and 24%),there was no grades III-IV complications occurred,there was no significant difference between two group(P>0.05).There are no death cases in two groups,patients presented with postoperative complications had fully recovered through aggressive treatment.Conclusion:LH possess several advantages of less influence on body,rapid postoperative recovery,shorter hospital stays.The volume of intraoperative bleeding,postoperative death rate and blood transfusion rate in LH group were similar with OH group.LH is recommended as a safe and feasible treatment option.LH may become a first surgical choice for the proper and selected patients with liver tumor,so that LH could gain the similar short-term outcomes compared with OH,which deserves to promote.