不同难度手术肝良性肿瘤患者腹腔镜肝切除术治疗的疗效分析:倾向性评分匹配研究

Efficacy analysis of laparoscopic hepatectomy in benign liver tumors patients with different difficult operations:propensity score matching study

目的比较针对不同难度手术的肝良性肿瘤患者采用腹腔镜或开腹肝切除术后的疗效差异。方法按照纳入和排除标准收集2014年9月至2021年3月期间在徐州医科大学附属医院接受手术治疗的肝良性肿瘤患者,对纳入的患者按Hasegawa肝切除难度评分模型分为低、中、高难度,然后对纳入的患者运用倾向性评分匹配后比较不同难度手术下采用腹腔镜(腔镜组)或开腹(开腹组)肝切除后患者的肝功能和炎性指标、术中出血量、手术时间、总住院时间、术后并发症、住院费用等情况。结果本研究共纳入符合纳入和排除标准的患者209例,低、中、高难度手术患者分别为59、89及61例,经1∶1倾向性评分匹配后低、中、高难度手术者腔镜组和开腹组各有18、34、14例患者得到匹配,不同难度手术者腔镜组和开腹组患者的基线资料比较差异均无统计学意义(P>0.05)。①低和中难度手术者,与开腹组比较,腔镜组丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、白细胞计数和中性粒细胞百分率的差值均更小(P<0.05),术中出血量及总住院时间均更少或更短(P<0.05),并且血清白蛋白的差值均高于开腹组(P<0.05);而高难度手术者2组患者在这些指标方面比较差异均无统计学意义(P>0.05)。②在手术时间方面,与开腹组比较,在低难度手术者腔镜组更短(P<0.05)而在高难度手术者腔镜组更长(P<0.05),在中难度手术者2组患者比较差异无统计学意义(P>0.05)。③在术后并发症方面,在低和高难度手术者2组间比较差异无统计学意义(P>0.05),而在中难度手术者腔镜组术后并发症率较开腹组更低(P<0.05)。④在住院费用方面,在高难度手术者腔镜组较开腹组更高(P<0.05),而在低和中难度手术者2组间比较差异无统计学意义(P>0.05)。⑤在总住院时间方面,不管手术难度如何,腔镜组均短于开腹组(P<0.05)。结论根据本研究结果,在低及中难度手术者,腹腔镜较开腹肝切除有较明显优势,大大缩短了患者总住院时间,能加速患者康复,即使在高难度手术者腹腔镜下肝切除仍体现出总住院时间缩短的优势。

Objective To compare efficacy of laparoscopic or open hepatectomy in benign liver tumors patients with different difficult operations.Methods According to the inclusion and exclusion criteria,the patients with benign liver tumors who underwent hepatectomy in the Affiliated Hospital of Xuzhou Medical University from September 2014to March 2021 were collected.The enrolled patients were assigned into low,medium,and high difficulties by the Hasegawa liver resection surgical difficulty score model,then the patients were matched by propensity score matching.The liver function and inflammatory indexes,intraoperative bleeding,operative time,total hospital stay,postoperative complications,and hospitalization expenses of patients with benign liver tumors after laparoscopic(laparoscope group)or open(open group)hepatectomy were compared.Results A total of 209 patients who met the inclusion and exclusion criteria were enrolled in this study.According to the Hasegawa criteria,there were 59,89,and 61 patients with low,medium,and high difficulties respectively.After 1∶1 propensity score matching,18,34,and 14 patients in the laparoscope group and open group were matched respectively.There were no statistic differences in the baseline data between the laparoscope group and open group(P>0.05).①For the patients with low and medium difficulties,compared with the open group,the different values of alanine aminotransferase,aspartate aminotransferase,white blood cell count,and neutrophil percentage were lower(P<0.05),the intraoperative bleeding and total hospital stay were less or shorter(P<0.05),and the albumin were higher(P<0.05)in the laparoscope group.There were no statistic differences in these indexes among the patients with high difficulty(P>0.05).②Compared with the open group,the operative time of the laparoscope group was shorter in the patients with low difficulty(P<0.05)and longer in the patients with high difficulty(P<0.05),and there was no statistic difference in patients with medium difficulty(P>0.05).③The postoperative complications had no statistic differences between the two groups for the patients with low and high difficulties(P>0.05),while which in the laparoscope group were lower than in the open group for the patients with medium difficulty(P<0.05).④The hospitalization expenses of the laparoscope group was higher than the open group for the patients with high difficulty(P<0.05),while which had no statistic differences between the two groups for the patients with low and medium difficulties(P>0.05).⑤The total hospital stay of the laparoscope group was shorter than the open group(P<0.05)no matter which difficult operation.Conclusions According to results of this study,laparoscopic hepatectomy has more obvious advantages as compared with open hepatectomy for patients with low or medium difficulty,which could greatly shorten hospital stay and accelerate rehabilitation of patients.Even for patients with high difficulty,laparoscopic hepatectomy still shows an advantage of shortening hospital stay.