腹腔镜肝切除术在肝癌合并肝硬化患者的应用

目的：探讨腹腔镜下肝切除（LH）与开腹肝切除（OH）在治疗肝癌合并肝硬化患者近期疗效之间的差别。方法选取2010年9月至2012年6月武汉大学人民医院住院的肝癌合并肝硬化患者78例，分为2组，其中LH组32例，OH组46例，分析比较2组术中、术后恢复以及术后复发之间的差别。计量资料采用成组t检验和配对t检验，计数资料采用χ2检验。结果2组比较，术中失血量，LH组显著低于OH组（t＝0．057，P＝0．040）；手术时间，LH组高于OH组（t＝3．101，P＝0．003）；术后并发症方面，电解质紊乱、胆漏、腹水，LH组显著低于OH组（t＝3．001，3．241，4．255，P均＜0．05）；术后第1天肝功能水平（AST、ALT），LH组显著低于OH组（t＝3．427、3．201，P＝0．001、0．002）；术后开始经口摄食的时间，LH组显著短于OH组（t＝3．012，P＝0．001）；住院时间LH组显著低于OH组（t＝2．157，P＝0．003）；肿瘤复发方面，LH组显著少于OH组（t＝2．751，P＝0．006）。结论对于肝癌合并肝硬化患者，LH较OH，无论在手术切口、术中失血量、术后腹水发生率、术后并发症、住院时间以及术后肿瘤的复发的发生方面都具有显著优势。

Clinical value of laparoscopic hepatectomy in liver cancer patients with cirrhosis

Objective To compare the perioperative outcomes of laparoscopic hepatectomy （LH）versus open hepatectomy （OH）for liver cancer patients with cirrhosis.Methods From September 2010 to June 2012,78 liver cancer patients with cirrhosis hospitalized in Renmin Hospital affiliated to Wuhan University were considered for liver resection;among them,32 patients were treated with LH,and 46 patients with OH.Intraoperative and postoperative conditions and tumor recurrence were compared between the two groups.Group t-test and paired t-test were used for measurement data,while chi-square test for enumeration data.Results The comparison of two groups indicated that the following indicators were significantly lower in the LH group than in the OH group：intraoperative blood loss （t=0.057,P=0.040）, incidence of postoperative complications （electrolyte imbalance,bile leakage,and ascites：t=3.001,3.241,and 4.255,respectively,P＆lt;0.05 for all）,liver function on the first day after operation （AST and ALT：t=3.427 and 3.201,P=0.001 and 0.002）,postoperative time to oral intake （t=3.012,P=0.001）,length of hospital stay （t =2.157,P=0.003）,and tumor recurrence （t =2.751,P=0.006）;whereas,the operative time in LH group was significantly longer than that in OH group （t=3.101,P=0.003）.Conclusion Compared with OH ,LH has various advantages in liver cancer patients with cirrhosis,such as smaller abdominal incision,less intraopera-tive blood loss,lower incidence of postoperative ascites,decreased postoperative complications,shorter hospital stay,and lower incidence of tumor recurrence.