腹腔镜下右半肝切除术治疗右肝肿瘤的围手术期疗效评估

目的比较腹腔镜下右半肝切除术与开腹右半肝切除术治疗右肝肿瘤的围手术期疗效。方法回顾性分析2015年1月至2016年6月浙江省人民医院收治的36例右半肝肿瘤行右半肝切除患者资料。根据手术方法分为腹腔镜右半肝切除组(15例)和开腹右半肝切除组(21例),比较两组患者围手术期疗效。结果腹腔镜右半肝切除组与开腹右半肝切除组在切口长度(8.93±1.53)cm vs(22.62±2.56)cm,t=19.992,P0.05]、手术时间(305.67±42.96)min vs(254.29±53.53)min,t=-3.073,P0.05]及术中出血量(386.67±201.31)mL vs(747.62±451.24)mL,t=3.242,P0.05]方面,组间差异均具有统计学意义。与开腹右半肝切除组相比,腹腔镜右半肝切除组术后胃肠道通气时间(2.60±1.30)d vs(9.24±4.22)d,t=2.107,P0.05]、术后住院时间(10.93±2.28)d vs(14.71±5.17)d,t=2.971,P0.05]及并发症发生率(13.33%vs 47.62%,χ~2=4.629,P0.05)均较低,组间差异有统计学意义。术中第一肝门阻断,腹腔镜右半肝切除组为2例,开腹右半肝切除组为8例,差异无统计学意义(χ~2=2.674,P0.05);术后标本肿瘤切缘,腹腔镜右半肝切除组为(8.13±3.74)mm,开腹右半肝切除组为(10.24±4.12)mm,组间差异学无统计学意义(t=1.569,P0.05)。结论腹腔镜下右半肝切除治疗右肝肿瘤方法可行,较开腹右半肝切除胃肠道功能恢复快,住院时间短,并发症少,具有创伤小、安全性高等特点,术后疗效肯定,值得临床推广。

The perioperative curative effect assessment of totally laparoscopic right hepatectomy in the treatment of right liver tumor

Objective To compare the perioperative curative effect of laparoscopic right hepatectomy and open right hepatectomy for right liver tumors. Methods The data of 36 patients with right liver tumor who un-derwent right hepatectomy in Zhejiang Provincial People's Hospital from Jan. 2015 to Jun. 2016 were retrospec-tivly analyzed. According to operation methods, the patients were divided into laparoscopic right hepatectomy group (n=15) and open right hepatectomy group (n=21). The perioperative curative effect were compared. Re-sults There was statistical difference in incision length (8.93±1.53) cm vs (22.62±2.56) cm, t=19.992, P<0.05], operation duration (305.67±42.96) min vs (254.29±53.53) min, t=-3.073, P<0.05] and intraoperative blood loss (386.67± 201.31) mL vs (747.62±451.24) mL, t=3.242, P<0.05] between laparoscopic right hepatectomy group and open right hepatectomy group. The postoperative ventilation time (2.60±1.30) d vs (9.24±4.22) d, t=2.107, P<0.05], postoperative hospitalization time (10.93±2.28) d vs (14.71±5.17) d, t=2.971, P<0.05] and complica-tion rate (13.33% vs 47.62%, χ2=4.629, P<0.05) in laparoscopic right hepatectomy group were lower than that in open right hepatectomy group. There was no statistical difference in number of the first hepatic portal occlusion (2 case vs 8 case, χ2=2.674, P>0.05), and postoperative tumor margin (8.13±3.74) mm vs (10.24±4.12) mm, t=1.569, P>0.05] between laparoscopic right hepatectomy group and open right hepatectomy group. Conclusion Compared with open right hepatectomy, laparoscopic liver resection in the treatment of right hepatic tumor is feasible, with quick recovery of gastrointestinal function, short hospitalization time, less complications, and small trauma, high safety.