腹腔镜与开腹肝切除术对老年肝脏恶性肿瘤患者的疗效分析

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 mL，开腹组为330 mL，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。

Liver resection of colorectal metastases in elderly patients

ObjectiveTo compare the curative effect and short-term benefits of laparoscopic liver resection with open liver resection in elderly patients with malignant liver tumors and medical comorbidities.MethodsPatients aged 70 and over who received liver resections for malignant liver tumors between January and October 2015 were enrolled. The perioperative outcomes of 17 patients with laparoscopic approach were matched and compared with those of 34 patients with conventional open approach in a 1:2 ratio.ResultsThere was no significant difference found between the two groups with regard to age, gender, incidence of comorbid illness, hepatitis B positivity, and Child-Pugh grading of liver function. The median tumor size was 3 cm for both groups. The types of liver resection were similar between the two groups with no significant difference in the duration of operation (laparoscopic: 195 min vs. open: 210 min, P=0.436). The perioperative blood loss was 150 mL in the laparoscopic group and 330 mL in the open group (P=0.046) with no significant difference in the number of patients with blood transfusion. The duration of hospital stay was 6 days (3-15 days) for the laparoscopic group and 8 days (5-105 days) for the open group (P=0.005).ConclusionLaparoscopic liver resection is safe and feasible for elderly patients. The short-term benefits of laparoscopic approach proves to be evident for geriatric oncological liver surgery.