手助腹腔镜与开腹肝切除术的临床对照研究

目的：探讨手助腹腔镜肝切除术的可行性及微创性。方法：随机将60例肝切除患者分为两组,30例行手助腹腔镜肝切除术,30例行开腹肝切除术,比较两组的手术时间、术中出血量、切口长度、术后肛门排气时间、术后住院时间、术后并发症、术前及术后第1、4、7天C反应蛋白（CRP）及中性粒细胞的动态变化。结果：手助腹腔镜组与开腹组的平均手术时间（114.3minvs.105.8min）和切缘距肿瘤边缘（3.22cmvs.3.33cm）差异无统计学意义（P〉0.05）。手助腹腔镜组术中平均出血量明显少于开腹组（212mlvs.376.5ml,P〈0.05）,切口长度差异有统计学意义（6.95cmvs.22cm,P〈0.01）。手助腹腔镜组术后胃肠功能恢复时间明显早于开腹组（术后肛门排气时间2.34dvs.3.48d,P〈0.05）。手助腹腔镜组住院时间明显短于开腹组（8.35dvs.10.8d,P〈0.01）。手助腹腔镜组与开腹组均无严重并发症发生。两组术后第7天CRP值比较有显著差异（23.23vs.63.35,P〈0.05）。两组于术后第4天中性粒细胞值比较有显著差异（6.45vs.9.51,P〈0.05）。结论：手助腹腔镜肝切除安全可行,并且具有创伤小、术后康复快等特点,是值得选择的微创肝切除方式。

Clinical comparative study of hand-assisted laparoscopic versus open hepatectomy

Objective:To study the feasibility and invasion of hand-assisted laparoscopic hepatectomy(HALH).Methods:Sixty patients with hepatectomy were divivded into HALH group and open hepatectomy(OH) group randomly from Dec.2004 to Jun.2006.Data of patients of two groups were compared.The index included operation time,blood loss,lergth of incision,postoperative venting time, hospital stay,complication,CRP and neutrophil.Results:The average operation time of HALH group was 114.3min,and it was 105.8min OH group(P>0.05).The intra-operative blood loss in HALH group was less than OH group(212ml vs.376.5ml,P<0.05).Lergth of incision of HALH group was shorter than OH group(6.95cm vs.22cm,P<0.01).The GI function of HALH group recovered faster than OH group (postoperative venting time was 2.34d vs.3.48d,P<0.05).The hospitalization was shorter(8.35d vs.10.8d,P<0.01).CRP in HALH group was lower than OH group on the seventh day(23.23 vs.63.35,P<0.05).Neutrophil in HALH group was lower than OH group on the fourth day(6.45 vs.9.51,P<0.05).Conclusions:Hand-assisted laparoscopic resection is feasible and safe for selected patients,with the advantages of little trauma and quick recovery.