CAJ | 학술논문

目的比较腹腔镜与开腹左肝切除术的疗效.方法前瞻性对照分析2010年5月至2011年6月哈尔滨医科大学附属第一医院92例行左肝切除术患者的临床资料.其中行腹腔镜下左肝切除术者42例(腹腔镜组),行开腹左肝切除术者50例(开腹组).对比腹腔镜与开腹左肝切除术治疗左半肝肿瘤的优缺点.计量资料采用t检验,计数资料采用x2检验和Fisher确切概率法.结果腹腔镜组患者施行肝左外叶切除29例,左半肝切除13例；其中1例伤及肝中静脉中转开腹.开腹组患者施行肝左外叶部分切除33例,左半肝切除17例.腹腔镜组患者的手术切缘距肿瘤距离为(1.6±0.6)cm,长于开腹组的(1.2±0.4)cm(t =3.81,P＜0.05).但腹腔镜组患者的术中出血量为(158±89) ml,明显少于开腹组的( 292±172) ml(t=4.56,P＜0.05).腹腔镜组患者的术后镇痛时间、胃肠道功能恢复时间和住院时间分别为(1.2±0.3)d、(23±4)h、(7.5±2.8)d,明显短于开腹组的(2.0±1.1)d、(49±7)h、(11.3±4.2)d(t=4.57,21.31,5.00,P＜0.05).腹腔镜组和开腹组患者术后第1天的AST、ALT较术前均有不同程度升高,但腹腔镜组升高的幅度较开腹组小(t=6.73,5.03,P＜0.05)；并且开腹组术后PT明显比术前延长(t=2.32,P＜0.05).腹腔镜组患者术后并发症发生率为7％ (3/41),住院费用为(2.5±0.7)万元,均较开腹组的8％(4/50)和(2.6±0.6)万元低,但差异无统计学意义(t=0.74,P＞0.05).开腹组患者中有l例术后因急性肝功能衰竭导致MODS死亡.结论腹腔镜左肝切除术成功率高,安全可行,与开腹手术比较具有手术创伤小、恢复快、总体疗效显著等优点.
목적 비교복강경여개복좌간절제술적료효.방법 전첨성대조분석2010년5월지2011년6월합이빈의과대학부속제일의원92례행좌간절제술환자적림상자료.기중행복강경하좌간절제술자42례(복강경조),행개복좌간절제술자50례(개복조).대비복강경여개복좌간절제술치료좌반간종류적우결점.계량자료채용t검험,계수자료채용x2검험화Fisher학절개솔법.결과 복강경조환자시행간좌외협절제29례,좌반간절제13례；기중1례상급간중정맥중전개복.개복조환자시행간좌외협부분절제33례,좌반간절제17례.복강경조환자적수술절연거종류거리위(1.6±0.6)cm,장우개복조적(1.2±0.4)cm(t =3.81,P＜0.05).단복강경조환자적술중출혈량위(158±89) ml,명현소우개복조적( 292±172) ml(t=4.56,P＜0.05).복강경조환자적술후진통시간、위장도공능회복시간화주원시간분별위(1.2±0.3)d、(23±4)h、(7.5±2.8)d,명현단우개복조적(2.0±1.1)d、(49±7)h、(11.3±4.2)d(t=4.57,21.31,5.00,P＜0.05).복강경조화개복조환자술후제1천적AST、ALT교술전균유불동정도승고,단복강경조승고적폭도교개복조소(t=6.73,5.03,P＜0.05)；병차개복조술후PT명현비술전연장(t=2.32,P＜0.05).복강경조환자술후병발증발생솔위7％ (3/41),주원비용위(2.5±0.7)만원,균교개복조적8％(4/50)화(2.6±0.6)만원저,단차이무통계학의의(t=0.74,P＞0.05).개복조환자중유l례술후인급성간공능쇠갈도치MODS사망.결론 복강경좌간절제술성공솔고,안전가행,여개복수술비교구유수술창상소、회복쾌、총체료효현저등우점.
Objective To compare the efficacy of laparoscopic and open left lobectomy.Methods The clinical data of 92 patients who received left lobectomy at the First Affiliated Hospital of Harbin Medical University from May 2010 to June 2011 were retrospectively analyzed.Of the 92 patients,42 received laparoscopic left lobectomy (laparoscopic group ) and 50 received open left lobectomy (open group ). The advantages and disadvantages between laparoscopic and open left lobectomy were compared. All data were analyzed using the t test,chi-square test or by calculating the Fisher exact probability.Results Twenty-nine patients received left lateral lobectomy and 13 patients received left hemihepatectomy in the laparoscopic group. One patient was converted to the open group becaused of the injury of the middle hepatic vein.Thirty-three patients nnderwent left lateral lobectomy and 17 underwent left hemihepatectomy in the open group.The tumor-free resection margin of the laparoscopic group was ( 1.6 ± 0.6 ) cm,which was significantly longer than ( 1.2 ± 0.4 ) cm of the open group (t=3.81,P＜0.05).The volume of operative blood loss of the laparoscopic group was (158 ±89)ml,which was significantly smaller than (292 ± 172)ml of the open group (t =4.56,P ＜ 0.05 ).The time of postoperative pain control,time to bowel function recovery and duration of hospital stay were ( 1.2 ± 0.3 )days,(23 ± 4)hours,( 7.5 ± 2.8 ) days in the laparoscopic group,which were significantly shorter than ( 2.0 ± 1.1 ) days,(4.9 ± 7 ) hours,( 11.3 ± 4.2 ) days in the open group,respectively ( t =4.57,21.31,5.00,P ＜ 0.05 ).The levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) at postoperative day 1 were increased,while the increase of AST and ALT in the open group were greater than that in the laparoscopic group (t =6.73,5.03,P ＜0.05).The postoperative prothrombin time in the open group was significantly longer than that before operation (t =2.32,P ＜ 0.05 ).The incidence of postoperative complications and total hospital costs were 7％ (3/41) and (2.5 ±0.7) ×104 yuan in the laparoscopic group,which were lower than 8％ (4/50) and (2.6 ±0.6) × 104 yuan in the open group,but no significant difference was observed (t =0.74,P ＞0.05).One patient in the open group died of multi-organ dysfunction syndrome caused by acute hepatic failure.Conclusion Laparoscopic left lobectomy is safe and effective,and it has the advantages of small trauma,quick recovery of patients and significant overall efficacy when compared with open left lobectomy.