CAJ | 학술논문

目的比较完全腹腔镜与开腹手术切除Ⅶ、Ⅷ段肝肿瘤的临床效果.方法回顾性分析2011年1月至2015年1月符合纳入标准接受手术治疗的Ⅶ、Ⅷ段肝肿瘤患者的临床资料,其中完全腹腔镜肝切除(laparoscopic liver resection,LLR) 17例,开腹肝切除(open liver resection,OLR)25例,比较2组间围手术期情况及近远期效果.结果 LLR组在术后第1、3天血清丙氨酸转氨酶(alanine aminotransferase,ALT)水平、术后通气时间、术后3d腹腔引流量以及术后住院时间方面较OLR组具有明显优势(分别t=-3.075、-3.175、-2.499、-2.088、-2.419,均P＜0.05).2组在输血率、切缘到肿瘤组织最小距离、并发症发生率、总医疗费用比较差异无统计学意义(x2=1.437,t=-1.244,x2=0.209,t =1.079,均P＞0.05).虽然手术时间和术中失血量LLR组较OLR组增加(分别t=3.360、2.189,均P＜0.05),但恶性肿瘤患者术后随访其复发率和生存率比较差异无统计学意义(分别x2=0.240、0.000,均P＞0.05).结论完全腹腔镜和开腹手术切除Ⅶ、Ⅷ段肝肿瘤的治疗效果相当,但前者更具有微创优势.
목적 비교완전복강경여개복수술절제Ⅶ、Ⅷ단간종류적림상효과.방법 회고성분석2011년1월지2015년1월부합납입표준접수수술치료적Ⅶ、Ⅷ단간종류환자적림상자료,기중완전복강경간절제(laparoscopic liver resection,LLR) 17례,개복간절제(open liver resection,OLR)25례,비교2조간위수술기정황급근원기효과.결과 LLR조재술후제1、3천혈청병안산전안매(alanine aminotransferase,ALT)수평、술후통기시간、술후3d복강인류량이급술후주원시간방면교OLR조구유명현우세(분별t=-3.075、-3.175、-2.499、-2.088、-2.419,균P＜0.05).2조재수혈솔、절연도종류조직최소거리、병발증발생솔、총의료비용비교차이무통계학의의(x2=1.437,t=-1.244,x2=0.209,t =1.079,균P＞0.05).수연수술시간화술중실혈량LLR조교OLR조증가(분별t=3.360、2.189,균P＜0.05),단악성종류환자술후수방기복발솔화생존솔비교차이무통계학의의(분별x2=0.240、0.000,균P＞0.05).결론 완전복강경화개복수술절제Ⅶ、Ⅷ단간종류적치료효과상당,단전자경구유미창우세.
Objective To compare the clinical effect of total laparoscopic and open liver resection for tumors in segments Ⅶ and Ⅷ.Methods The clinical data of patients with tumors in segments Ⅶ and Ⅷ of the liver who met the inclusion criteria and received operation at Affiliated Hospital of Nantong University from January 2011 to January 2015 were retrospectively analyzed.Among these patients, there were 17 cases who received total laparoscopic liver resection (LLR group), and 25 cases who received open liver resection (OLR group).Results LLR group has obvious advantages in aspects of the level of serum alanine transaminase (ALT) on 1st and 3rd day postoperation, the time anal exsufflation, the drainage volume of abdominal cavity in 3 days after operation and the postoperative hospital stay than those in OLR group (respectively t =-3.075,-3.175,-2.499,-2.088,-2.419, all P ＜ 0.05).There were no significant differences in blood transfusion rate, the resection margin to the tumor, the postoperative morbidity and the total medical cost between the two groups (x2 =1.437, t =-1.244, x2 =0.209, t =1.079, all P ＞ 0.05).Though the mean operative time and intraoperative blood loss of LLR group compared with OLR group increased obviously (respectively t =3.360, 2.189, all P ＜ 0.05).During the postoperative follow-up, there were no significant differences in the postoperative recurrence rate and the long-term survival rate in patients with malignant tumors (respectively x2 =0.240, 0.000, all P ＞ 0.05).Conclusion The therapeutic effect of total laparoscopic and open liver resection are equal in segments Ⅷ and Ⅷ hepatectomy, while, LLR has advantages of less trauma.