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目的比较腹腔镜和开腹肝切除术在具有伴发疾病的老年肝脏恶性肿瘤患者中的疗效和短期获益。方法纳入自2015年4—10月期间因肝脏恶性肿瘤接受肝切除的70岁及以上患者。17例腹腔镜手术患者的围手术期结果按照1∶2的比例与传统开腹手术患者相匹配。结果两组患者的年龄、性别、合并症发病率、乙型肝炎阳性率,肝功能Child评分无统计学差异。两组中位肿瘤大小均为3 cm。两组之间肝切除类型相似,手术时间无明显差异(腹腔镜195 min vs.开腹210 min,P=0.436)。腹腔镜组围手术期失血量为150 m L,开腹组为330 m L,差异无统计学意义(P=0.046)。腹腔镜组平均住院时间为6 d(3~15 d),开腹组为8 d(5~105 d)(P=0.005)。结论腹腔镜肝切除术对老年患者是安全可行的。腹腔镜手术的短期获益在老年患者肝脏肿瘤手术中仍然显见。
Objective To compare the efficacy and short-term benefit of laparoscopic and open hepatectomy in elderly patients with malignant liver tumors with concomitant diseases. METHODS: Patients aged 70 and over who underwent hepatectomy for liver malignancies from April to October 2015 were enrolled. The perioperative results of 17 patients undergoing laparoscopic surgery matched the traditional open surgery patients at a 1: 2 ratio. Results There was no significant difference in age, gender, incidence of comorbidity, positive rate of hepatitis B, and Child score of liver function between the two groups. The median tumor size in both groups was 3 cm. There was no significant difference in the type of liver resection between the two groups (laparoscopic 195 min vs. laparotomy 210 min, P = 0.436). Perioperative laparoscopic group blood loss was 150 m L, open group was 330 m L, the difference was not statistically significant (P = 0.046). The average length of stay in the laparoscopic group was 6 days (ranged from 3 to 15 days) and in the open group was 8 days (ranged from 5 to 105 days) (P = 0.005). Conclusions Laparoscopic liver resection is safe and feasible in elderly patients. The short-term benefit of laparoscopic surgery is still evident in liver tumor surgery in elderly patients.