腹腔镜与开腹左半肝切除术治疗肝脏恶性肿瘤的疗效对比

目的:探讨腹腔镜左半肝切除术治疗肝脏恶性肿瘤的安全性、可行性及其相较开腹手术的临床优势。方法:回顾分析2015年1月至2017年12月行左半肝切除术的147例恶性肿瘤患者的临床资料,其中腹腔镜左半肝切除术42例(腔镜组),开腹左半肝切除术105例(开腹组)。对比分析两组术中、围手术期及术后随访资料。结果:两组患者性别、年龄、肿瘤直径、各项血生化指标、合并疾病等临床资料差异无统计学意义(P>0.05)。腔镜组手术时间(196.3±48.6)min vs.(225.7±69.1)min]、术中出血量(232.6±68.3)mL vs.(302.7±108.4)mL]、术后排气时间(3.4±0.8)d vs.(4.9±1.3)d]及术后住院时间(6.8±2.1)d vs.(9.4±2.6)d]均低于开腹组,差异有统计学意义(P<0.05);术后第1天、第3天、第7天,腔镜组转氨酶水平、血清白蛋白水平均优于开腹组,差异有统计学意义(P<0.05)。在术后并发症方面,开腹组术后总并发症发生率为37.1%,高于腔镜组的9.5%(P=0.002);其中开腹组术后切口液化发生率高于腔镜组(P=0.030),但两组胆漏、顽固性腹水、腹腔出血及切口感染等并发症发生率差异无统计学意义(P>0.05)。腔镜组术后1年、2年及3年生存率分别为93.6%、84.6%与66.9%,开腹组为94.5%、81.4%与68.5%,两组各时点生存率差异无统计学意义(P=0.708)。结论:腹腔镜左半肝切除术治疗肝脏恶性肿瘤是安全、可行的,腹腔镜手术的术中及术后恢复情况优于开腹手术。

The effectiveness of laparoscopic versus open left hemihepatectomy for hepatic malignant tumors

Objective:To discuss the safety and feasibility of laparoscopic left hemihepatectomy for hepatic malignant tumors and its clinical advantages compared with laparotomy.Method:The clinical data of 147 patients with malignant tumors who underwent left hemihepatectomy from Jan.2015 to Dec.2017 in the department of hepatobiliary surgery,first medical center of PLA general hospital were analyzed retrospectively,including 42 cases of laparoscopic left hemihepatectomy and 105 cases of open left hemihepatectomy.The clinical data of the two groups was compared.Results:There was no significant difference in gender,age,tumor diameter,blood biochemical parameters or other combined diseases between the two groups(P>0.05).The average operation time(196.3±48.6)min vs.(225.7±69.1)min],intraoperative bleeding(232.6±68.3)mL vs.(302.7±108.4)mL],postoperative exhaust time(3.4±0.8)d vs.(4.9±1.3)d]and postoperative hospital stay(6.8±2.1)d vs.(9.4±2.6)d]of the laparoscopic group were significantly lower than those of the laparotomy group(P<0.05).In addition,the average transaminase level and serum albumin level in the laparoscopic group were significantly better than those in the laparotomy group in postoperative day 1,3,and 7(P<0.05).The incidence of postoperative complications in the laparotomy group was 37.1%,which was significantly higher than that in the laparoscopic group(9.5%,P=0.002).More specifically,the incidence of incision liquefaction in the laparotomy group was significantly higher than that in the laparoscopic group(P=0.030),but there was no significant difference in the incidence of bile leakage,intractable ascites,abdominal bleeding or incision infection between the two groups(P>0.05).Furthermore,the survival rate of the laparoscopic group in the first,the second and the third year after operation was 93.6%,84.6%and 66.9%respectively,it was 94.5%,81.4%and 68.5%in the laparotomy group correspondingly.No significant difference was detected between the two groups(P=0.708).Conclusions:Laparoscopic left hemihepatectomy is safe and feasible for the treatment of malignant liver tumors.Meanwhile,it has some advantages than laparotomy in the operation and during the postoperative recovery.