腹腔镜与开腹肝切除术治疗肝细胞性肝癌的安全性及短期疗效对比

Safety of laparoscopic hepatectomy and open hepatectomy and its clinical value in postoperative accelerated rehabilitation of liver cancer

目的比较腹腔镜与开腹行肝切除术治疗肝细胞性肝癌患者的安全性及对术后康复的影响。方法回顾性分析2023年1月至6月期间,中国科学技术大学附属第一医院(安徽省立医院)普外科接受腹腔镜或开腹肝切除术治疗66例肝癌患者的临床资料,并对其进行回顾性分析。按照手术方法,将其分成腹腔镜组(37例)和开腹组(29例)。比较2组的围术期相关指标,包括术中出血量、术中是否输血、手术时间、肝门阻断时间、切口长度、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、并发症、术后首次下床时间、术后首次进食时间、术后住院时间、住院期间总花费。结果腹腔镜组的术中出血量为(134.86±28.64)mL,低于开腹组(283.10±90.28)mL(t=9.41,P<0.05)。腹腔镜组手术时间(124.30±20.42)min,低于开腹组(176.20±17.40)min(t=10.93,P<0.05);切口长度、术后第3天ALT、AST分别为(5.92±1.50)cm、(248.35±44.76)U/L、(244.68±55.62)U/L,均低于开腹组(17.59±2.29)cm、(306.48±38.81)U/L、(292.76±58.92)U/L(t=24.94,t=5.54,t=3.40;P<0.05)。腹腔镜组手术并发症发生率(13.5%)低于开腹组(41.3%)(χ2=6.60,P<0.05)。腹腔镜组术后首次下床时间、术后首次进食时间、术后住院时间、住院期间总花费分别为(1.49±0.51)d、(1.59±0.55)d、(7.59±1.62)d、(28889.96±6471.64)元,早于或低于开腹组(2.48±0.51)d、(2.97±0.63)d、(11.66±1.90)d、(33381.73±11494.97)元(t=7.92,t=9.45,t=9.37,t=2.01;P<0.05)。结论腹腔镜肝切除手术治疗肝细胞性肝癌安全性良好,近期恢复效果优于开腹肝切除手术,同时对肝癌术后的肝脏损伤较小,有利于患者的术后加速康复。

Objective To comparie of the safety and postoperative rehabilitation effect of laparoscopic and open hepatectomy for liver cancer.Methods The complete clinical data of 66 patients with liver cancer who received surgical treatment in the department of General Surgery of the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,from January to June 2023 were selected for retrospective analysis,and they were divided into open surgery group(n=29)and laparoscopic surgery group(n=37)according to different surgical methods.The perioperative related indicators of the two groups were compared,including operation time,blood loss during surgery,blood transfusion during surgery,incision length,hepatic portal block time,Alanine aminotransferase(ALT),Aspartate aminotransferase(AST),Total bilirubin(TBIL),complication rate,postoperative ambulation time,first eating time after surgery,days of hospital stay after surgery,hospitalization expenses.Results The blood loss during surgery in laparoscopic group was(134.86±28.64)mL,which was lower than(283.10±90.28)mL in open group(t=9.41,P<0.05).The operation time in laparoscopic group was(124.30±20.42)min,which was shorter than(176.20±17.40)min than that in open group(t=10.93,P<0.05).The incision length,ALT and AST on the third day after operation were(5.92±1.50)cm,(248.35±44.76)U/L and(244.68±55.62)U/L,which were shorter or lower or quicker than(17.59±2.29)cm,(306.48±38.81)U/L and(292.76±58.92)U/L those in open surgery group(t=24.94,t=5.54,t=3.40;P<0.05).The incidence of surgical complications in laparoscopic group(13.5%)was lower than that(41.3%)in open group(χ2=6.60,P<0.05).The time to stand besides bed after surgery,the time to eat or drink for the first time after surgery,the time to stay in hospital after operation and the hospitalization expenses of treatment in laparoscopic group were(1.49±0.51)d,(1.59±0.55)d,(7.59±1.62)d and(28889.96±6471.64)yuan,which were earlier or lower than(2.48±0.51)d,(2.97±0.63)d,(11.66±1.90)d and(33381.73±11494.97)yuan in open group(t=7.92,t=9.45,t=9.37,2.01;P<0.05).Conclusions Laparoscopic hepatectomy is safe in the treatment of liver cancer.The short-term recovery effect is better than open hepatectomy.At the same time,it has less influence on postoperative liver function with more conducive to patients′postoperative rehabilitation.