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背景与目的:随着腹腔镜技术在肝脏外科中的应用日渐广泛,腹腔镜肝切除的安全性和可行性逐步得到了认可,该研究旨在探讨腹腔镜肝肿瘤切除术与开腹肝肿瘤切除术的可行性与临床疗效。方法:回顾性分析复旦大学附属肿瘤医院2015年3月—2016年3月37例接受腹腔镜肝肿瘤切除术与74例接受传统开腹肝肿瘤切除术患者的临床资料,计量资料采用Wilcoxon秩和检验,统计值为Z,计数资料采用Fisher精确概率检验;分析手术时间、术中出血量、手术后胃肠道恢复时间、手术后引流管拔管时间、住院时间、术后并发症和住院费用等临床资料。腹腔镜组:男性20例,女性17例,年龄18~76岁(中位年龄55岁);开腹组:男性42例,女性32例,年龄26~74岁(中位年龄54岁)。切肝方式为超声刀+单极电凝,结合腹腔镜下切割缝合器。腹腔镜组的手术方式包括:局部切除13例;行肝段或肝叶解剖性切除24例。开腹组的手术方式包括:局部切除33例;行肝段或肝叶解剖性切除41例。结果:手术平均用时:腹腔镜组为149 min(40~204 min),开腹组为142 min(45~190 min)。术中出血量:腹腔镜组为220 m L(30~570 m L),开腹组为360 m L(90~970 m L)。平均住院时间:腹腔镜组为4.9 d(3.0~6.0 d),开腹组为6.8 d(5.0~9.0 d)。手术后胃肠道恢复平均时间:腹腔镜组为1.1 d,开腹组为2.3 d。手术后引流管拔管时间:腹腔镜组为3.1 d,开腹组为5.8 d。平均住院费用:腹腔镜组为38 760元,开腹组为39 145元。手术后并发症:腹腔镜组为8.1%(3/37),开腹组为9.5%(7/74)。结论:腹腔镜肝切除术是一种安全、有效、微创的手术,可安全用于局部、肝段及半肝切除术,值得推广使用。
BACKGROUND & OBJECTIVE: With the increasing use of laparoscopy in liver surgery, the safety and feasibility of laparoscopic liver resection has been gradually recognized. This study aims to investigate the feasibility of laparoscopic liver resection versus open hepatectomy The feasibility and clinical efficacy of surgery. Methods: The clinical data of 37 patients undergoing laparoscopic hepatic tumor resection and 74 patients undergoing conventional open hepatic tumor resection were retrospectively analyzed. The measurement data were analyzed by Wilcoxon rank sum Test, statistical value of Z, count data using Fisher exact test; analysis of operation time, intraoperative blood loss, postoperative gastrointestinal recovery time, postoperative drainage tube extubation time, hospital stay, postoperative complications and hospitalization costs Other clinical data. Laparoscopic group: 20 males and 17 females, aged 18 to 76 years (median age 55 years); open group: 42 males and 32 females, aged 26 to 74 years (median age 54 years). Cut the liver for the ultrasound knife + unipolar coagulation, combined with laparoscopic stapler. Laparoscopic group of surgical methods include: partial resection in 13 cases; hepatic segmental or hepatic lobectomy in 24 cases. Open surgery group methods include: 33 cases of partial resection; hepatic segment or liver lobectomy 41 cases. Results: The mean time of operation was 149 min (40-204 min) in laparoscopic group and 142 min (45-190 min) in open group. The intraoperative blood loss was 220 m L (30-570 m L) in the laparoscopic group and 360 m L (90-970 m L) in the open group. The average length of stay was 4.9 d (3.0-6.0 d) in the laparoscopic group and 6.8 d (5.0-9.0 d) in the laparotomy group. The average time of gastrointestinal recovery after operation was 1.1 d in laparoscopic group and 2.3 d in open group. Postoperative drainage tube extubation time: laparoscopic group 3.1 d, open group 5.8 d. The average cost of hospitalization: laparoscopic group was 38,760 yuan, open group was 39,145 yuan. Postoperative complications were 8.1% (3/37) in the laparoscopic group and 9.5% (7/74) in the open group. Conclusion: Laparoscopic hepatectomy is a safe, effective and minimally invasive surgery, which can safely be used for local, hepatic and hepatic resection and is worth promoting.