目的 通过与开腹精准肝切除术的对比研究,探讨腹腔镜解剖性肝切除术治疗肝癌的临床疗效.方法 采用回顾性对照研究,收集2011年1月-2013年12月,南京大学医学院附属鼓楼医院手术治疗肝癌病例共46例,按照手术方式分为腹腔镜解剖性肝切除术组(简称腹腔镜组)和开腹精准肝切除术组(简称开腹组),其中腹腔镜组19例,开腹组27例.比较两组手术时间、术中出血量和入肝血流阻断时间的差异,以及术后住院时间、胃肠功能恢复时间、血清肝功能指标、病灶病理切缘、术后并发症、住院总费用等.结果 (1)两组病例围手术期间均无死亡.(2)与开腹组比较,腹腔镜组入肝血流阻断时间缩短,差异具有统计学意义(P ＜0.05,F=8.662);与开腹组比较,腹腔镜组手术时间和术中出血虽有所减少,但差异未检验出统计学意义(P＞0.05,F=1.481,F=0.539).(3)与开腹组比较,腹腔镜组术后胃肠功能恢复时间较快,术后住院时间缩短,差异有显著统计学意义(P＜0.01,F=7.691,F=11.408).(4)与开腹组比较,腹腔镜组术后1、3d的血清ALT和AST均有所降低,但仅有术后第3天AST差异有统计学意义(P ＜0.05,F=4.226),术后第1、3天的CRP均有所降低,但差异未检出统计学意义(P ＞0.05,F=0.792,F=0.007).与开腹组比较,术后血清TB和DB的差异无统计学意义(P＞0.05,F=2.002、F=0.021,F=0.442、F=1.392);(5)与开腹组比较,腹腔镜组住院费用增加,但差异未检出统计学意义(P ＞0.05,F=0.046).(6)与开腹组比较,腹腔镜组的病理切缘阳性率的差异虽然未检出统计学意义(P＞0.05,x2=1.453),但有1例病理切缘为阳性.结论 腹腔镜肝切除治疗肝癌安全、可行,体现了微创优势.但与开腹精准肝切除比较,在肿瘤的根治性方面尚存争议,有待进一步的临床研究.
目的 通過與開腹精準肝切除術的對比研究,探討腹腔鏡解剖性肝切除術治療肝癌的臨床療效.方法 採用迴顧性對照研究,收集2011年1月-2013年12月,南京大學醫學院附屬鼓樓醫院手術治療肝癌病例共46例,按照手術方式分為腹腔鏡解剖性肝切除術組(簡稱腹腔鏡組)和開腹精準肝切除術組(簡稱開腹組),其中腹腔鏡組19例,開腹組27例.比較兩組手術時間、術中齣血量和入肝血流阻斷時間的差異,以及術後住院時間、胃腸功能恢複時間、血清肝功能指標、病竈病理切緣、術後併髮癥、住院總費用等.結果 (1)兩組病例圍手術期間均無死亡.(2)與開腹組比較,腹腔鏡組入肝血流阻斷時間縮短,差異具有統計學意義(P ＜0.05,F=8.662);與開腹組比較,腹腔鏡組手術時間和術中齣血雖有所減少,但差異未檢驗齣統計學意義(P＞0.05,F=1.481,F=0.539).(3)與開腹組比較,腹腔鏡組術後胃腸功能恢複時間較快,術後住院時間縮短,差異有顯著統計學意義(P＜0.01,F=7.691,F=11.408).(4)與開腹組比較,腹腔鏡組術後1、3d的血清ALT和AST均有所降低,但僅有術後第3天AST差異有統計學意義(P ＜0.05,F=4.226),術後第1、3天的CRP均有所降低,但差異未檢齣統計學意義(P ＞0.05,F=0.792,F=0.007).與開腹組比較,術後血清TB和DB的差異無統計學意義(P＞0.05,F=2.002、F=0.021,F=0.442、F=1.392);(5)與開腹組比較,腹腔鏡組住院費用增加,但差異未檢齣統計學意義(P ＞0.05,F=0.046).(6)與開腹組比較,腹腔鏡組的病理切緣暘性率的差異雖然未檢齣統計學意義(P＞0.05,x2=1.453),但有1例病理切緣為暘性.結論 腹腔鏡肝切除治療肝癌安全、可行,體現瞭微創優勢.但與開腹精準肝切除比較,在腫瘤的根治性方麵尚存爭議,有待進一步的臨床研究.
목적 통과여개복정준간절제술적대비연구,탐토복강경해부성간절제술치료간암적림상료효.방법 채용회고성대조연구,수집2011년1월-2013년12월,남경대학의학원부속고루의원수술치료간암병례공46례,안조수술방식분위복강경해부성간절제술조(간칭복강경조)화개복정준간절제술조(간칭개복조),기중복강경조19례,개복조27례.비교량조수술시간、술중출혈량화입간혈류조단시간적차이,이급술후주원시간、위장공능회복시간、혈청간공능지표、병조병리절연、술후병발증、주원총비용등.결과 (1)량조병례위수술기간균무사망.(2)여개복조비교,복강경조입간혈류조단시간축단,차이구유통계학의의(P ＜0.05,F=8.662);여개복조비교,복강경조수술시간화술중출혈수유소감소,단차이미검험출통계학의의(P＞0.05,F=1.481,F=0.539).(3)여개복조비교,복강경조술후위장공능회복시간교쾌,술후주원시간축단,차이유현저통계학의의(P＜0.01,F=7.691,F=11.408).(4)여개복조비교,복강경조술후1、3d적혈청ALT화AST균유소강저,단부유술후제3천AST차이유통계학의의(P ＜0.05,F=4.226),술후제1、3천적CRP균유소강저,단차이미검출통계학의의(P ＞0.05,F=0.792,F=0.007).여개복조비교,술후혈청TB화DB적차이무통계학의의(P＞0.05,F=2.002、F=0.021,F=0.442、F=1.392);(5)여개복조비교,복강경조주원비용증가,단차이미검출통계학의의(P ＞0.05,F=0.046).(6)여개복조비교,복강경조적병리절연양성솔적차이수연미검출통계학의의(P＞0.05,x2=1.453),단유1례병리절연위양성.결론 복강경간절제치료간암안전、가행,체현료미창우세.단여개복정준간절제비교,재종류적근치성방면상존쟁의,유대진일보적림상연구.
Objective To evaluate the clinical efficacy of 1 aparoscopic anatomical hepatectomy (LaHt)in the treatment of liver cancer by comparing with Open precise hepatectomy (OHt).Methods Forty-six cases of liver tumor hepatectomy were collected by the none randomized controlled trails (non-RCTs) from January 2011 to December 2013 in Department of Hepato-Biliary-Pancreatic Surgery,Nanjing Drum Tower Hospital.According to the operation method,they were divided into two groups,including 19 cases of LaHt group and 27 cases of OHt group.Compare differences of their operation time,intraoperative blood loss,time of Pringle maneuver,and postoperative hospital stay,time of postoperative gastrointestinal function recovery,Serum liver function index,pathological tumor margin,postoperative complications,total hospitalization expenditures.Results (1) No perioperative mortality was observed in the 2 groups.(2) Compared with OHt group,LaHt group had shorter Pringle maneuver time with statistical significance (P ＜ 0.05,F =8.662) ; while,LaHt group also had less hemorrhage and shorter operation time than OHt group,although statistical significance did not existed (P ＞ 0.05,F =1.481,F =0.539).(3) Compare with OHt group,postoperative gastrointestinal function recovery of LaHt group was faster while postoperative length of hospital stay of LaHt group was shorter with obviously statistical significances existed (P ＜ 0.01,F =7.691,F =11.408).(4) The liver function index serum ALT,AST of LaHt group is lower compared to that of OHtgroup postoperative dayl and 3,however,only the day 3 AST had statistical significance (P ＜ 0.05,F =4.226).LaHt group had lower CRP level than OHt group on both day 1 and 3 after surgery,but there was no statistical significance(P ＞ 0.05,F =0.792,F =0.007).Serum TB and DB varied little between LaHt and OHt group on both day 1 and 3 after surgery without statistical significance (P ＞ 0.05,F =2.002,F =0.021,F =0.442,F =1.392).(5) The average hospital charges for the patients in LaHt group is higher than that in OH group,but there was still no statistical significance (P ＞ 0.05,F =0.046).(6) Although there was no significant difference between LaHt and OH in positive/negative excision margin ratio (P ＞0.05,x2 =1.453),there was 1 case of excision margin residues in LaHt group which would have negative effects on the prognoses.Conclusions Laparoscopic hepatectomy is a safe and feasible surgical approach,with minimally invasive advantage for treatment of liver cancer.However,compared with open precise hepatectomy,there are still some deficiencies in terms of radical curative aspect.
