腹腔镜与开腹肝切除术安全性及近期疗效比较

Comparison of safety and short-term efficacy between laparoscopic hepatectomy and open hepatectomy

目的探讨腹腔镜与开腹肝切除术的安全性及近期疗效。方法回顾性分析2015年1月至2019年12月在内蒙古医科大学附属医院行肝切除术的125例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。根据手术方式不同,将患者分为腹腔镜肝切除术组(腹腔镜组,60例)和开腹肝切除术组(开腹组,65例)。其中腹腔镜组男35例,女25例;年龄16~75岁,中位年龄55岁。开腹组男37例,女28例;年龄15~76岁,中位年龄54岁。两组手术时间、年龄等比较采用t检验,术后并发症发生率比较采用χ2检验。结果两组患者均顺利完成手术。腹腔镜组有5例中转开腹,中转开腹率为8%(5/60),无死亡病例。腹腔镜组平均手术时间为(145±53)min,明显长于开腹组的(128±30)min(t=2.267,P<0.05)。腹腔镜组术后排气时间、首次下床活动时间、镇痛药使用时间、腹腔引流时间、术后住院时间分别为(2.5±0.7)、(1.7±0.6)、(2.1±0.7)、(5.1±2.2)、(6.4±2.6)d,明显短于开腹组的(3.0±0.7)、(3.0±0.7)、(2.8±1.5)、(7.0±1.7)、(8.8±2.1)d(t=-4.195,-11.164,-4.024,-5.456,-5.701;P<0.05)。腹腔镜组术后出血2例、胆漏3例、感染2例,开腹组相应为4、8、6例,腹腔镜组术后并发症发生率明显低于开腹组(χ^2=5.008,P<0.05)。结论与开腹手术相比,腹腔镜肝切除术安全、近期疗效好、并发症率低,具有微创、恢复快的优势。

Objective To compare the safety and short-term efficacy of laparoscopic and open hepatectomy.Methods Clinical data of 125 patients who underwent hepatectomy in the Affiliated Hospital of Inner Mongolia Medical University from January 2015 to December 2019 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.According to different surgical procedure,all patients were divided into the laparoscopic hepatectomy(n=60)and open hepatectomy groups(n=65).In the laparoscopic hepatectomy group,35 patients were male and 25 female,aged 16-75 years,with a median age of 55 years.In the open hepatectomy group,37 patients were male and 28 female,aged 15-76 years,with a median age of 54 years.The operation time,age were compared between two groups by t test.The incidence of postoperative complications was compared by Chi-square test.Results All patients in two groups successfully completed the operation.In the laparoscopic hepatectomy group,5 cases were converted to open hepatectomy with a conversion rate of 8%(5/60).No death case was reported.The average operation time in the laparoscopic hepatectomy group was(145±53)min,significantly longer than(128±30)min in the open hepatectomy group(t=2.267,P<0.05).In the laparoscopic hepatectomy group,the postoperative exhaust time,first off-bed activity time,analgesic use time,abdominal drainage time and postoperative length of hospital stay were(2.5±0.7),(1.7±0.6),(2.1±0.7),(5.1±2.2)and(6.4±2.6)d,significantly shorter than(3.0±0.7),(3.0±0.7),(2.8±1.5),(7.0±1.7)and(8.8±2.1)d in the open hepatectomy group(t=-4.195,-11.164,-4.024,-5.456,-5.701;P<0.05).In the laparoscopic hepatectomy group,2 cases developed postoperative bleeding,3 cases of bile leakage and 2 cases of infection,and it was 4,8 and 6 cases accordingly in the open hepatectomy group.The incidence of postoperative complications in laparoscopic hepatectomy group was significantly lower than that in the open hepatectomy group(χ^2=5.008,P<0.05).Conclusions Compared with open hepatectomy,laparoscopic hepatectomy has advantages in terms of higher safety,better short-term efficacy,fewer postoperative complications,less invasiveness and faster postoperative recovery.