腹腔镜与开腹肝切除术治疗肝血管瘤的疗效分析:倾向性评分匹配研究

Efficacy between laparoscopic and open hepatectomy for hepatic hemangioma:a propensity score matching study

目的比较腹腔镜与开腹肝切除术治疗肝血管瘤的疗效。方法纳入2015年5月至2019年9月在复旦大学附属中山医院接受腹腔镜或开腹手术治疗的肝血管瘤患者119例,采用倾向性评分匹配(propensity score matching,PSM)对两组患者基本资料进行匹配,回顾分析两组患者手术疗效、术后恢复、住院时间和住院费用。结果两组患者术中失血量、术中输血率、术中肝门阻断率、术后引流量、并发症、住院时间差异均无统计学意义。腹腔镜组的患者肝门阻断时间显著长于开腹组[(26.1±11.5)min vs.(15.0±10.0)min,P<0.001],住院费用显著高于开腹组[(44934.6±7328.6)元vs.(36212.4±7247.4)元,P<0.001]。腹腔镜患者组术后白蛋白水平较高,谷丙转氨酶、谷草转氨酶水平及直接胆红素水平低于开腹组,且C反应蛋白、白细胞计数、中性粒细胞比例和降钙素原水平低于开腹组,差异有统计学意义(P<0.05)。在特定肝段(Ⅰ、Ⅶ、Ⅷ段)和巨大肝血管瘤(直径≥10.0 cm)中得到的结果类似。结论腹腔镜肝血管瘤切除术不仅具有与开腹手术相似的有效性和安全性,而且有全身炎症反应轻、对肝脏损伤小、术后肝功能恢复快等优点。腹腔镜手术在特定肝段(Ⅰ、Ⅶ、Ⅷ段)血管瘤及经过适当选择的巨大血管瘤治疗中同样具有优势。

Objective To compare the efficacy of laparoscopic and open hepatectomy for hepatic hemangioma.Methods One hundred and nineteen patients who had been treated for hepatic hemangioma with either a laparoscopic or an open hepatectomy in Zhongshan Hospital of Fudan University between May 2015 and Sep 2019 were included in the study.Propensity score matching(PSM)was performed to match baseline characteristics of the two groups.The perioperative outcomes,hospital stay,and hospitalization expense of the two groups were retrospectively reviewed.Results There was no statistic difference in intraoperative blood loss,transfusion rate,hepatic portal occlusion,postoperative drainage,complications,and hospital stay between the two groups.Patients in laparoscopic group experienced significant longer duration of hepatic portal occlusion[(26.1±11.5)min vs(.15.0±10.0)min,P<0.001]and higher hospitalization expense[(44934.6±7328.6)yuan vs.(36212.4±7247.4)yuan,P<0.001]compared with the open hepatectomy group.However,the laparoscopic group had higher postoperative albumin level and lower levels of alanine aminotransferase,glutamic oxaloacetylase,direct bilirubin,C-reactive protein,leukocyte count,proportion of neutrophils,and procalcitonin than the open hepatectomy group(P<0.05).Similar results were observed in specific hepatic segments(Ⅰ,Ⅶ,Ⅷ)and giant hepatic hemangioma(diameter≥10.0 cm).Conclusion Laparoscopic hepatectomy for hepatic hemangioma has a similar efficacy and safety as open approach with the advantages of milder systemic inflammatory response,less liver damage and faster functional recovery,even in patients with tumor located in specific hepatic segments(Ⅰ,Ⅶ,Ⅷ)or selected giant hemangioma.