全腹腔镜与手助腹腔镜在困难肝切除中的临床对照研究

目的比较手助腹腔镜肝切除技术在困难肝切除中的临床价值。方法回顾分析2010年1月~2012 年12月64例腹腔镜困
难肝切除患者的临床资料，其中全腹腔镜手术41 例，手助腹腔镜手术23例。对比分析手助式、完全腹腔镜肝切除术的差异。结
果两组患者一般资料比较差异无统计学意义（P>0.05），具可比性。手助腹腔镜组与全腔镜组的平均手术时间（240 vs 191 min），
出血量（430 vs 220 ml）的差异有统计学意义（P<0.05），两组在平均住院费用方面的差异也有统计学意义（5.87 vs 4.74万）。但
并发症发生率及术后住院时间的差异均无统计学意义，两组患者中恶性肿瘤的1年和2年复发率的差异也没有统计学意义。结
论手助腹腔镜肝切除适用于一些风险较大的肝脏切除，具有手术时间短、术中出血少，总费用低等优势，作为全腹腔镜肝切除
技术的一种补充，值得进行深入的研究评估。

A comparative study of hand- assisted laparoscopic versus pure laparoscopic major hepatectomy

Objective To compare the outcomes of hand-assisted laparoscopic liver surgery (HALS) and pure laparoscopic liver
surgery (PLS). Methods The clinical data were analyzed for 64 patients undergoing major hepatectomy with HALH (23 cases)
and PLS (41 cases) between January, 2010 and December, 2012. Results The general data of the two groups were comparable.
Compared with PLS, HALS was associated with a significantly shorter operative time (240 vs 191 min), less intraoperative
blood loss (430 vs 220 ml, P<0.05), and a lower cost (P<0.05). There was no significant difference between the two groups in
postoperative hospital stay, complication rates or recurrence rate of hepatocellular carcinoma. Conclusions HALS is safe for
major liver resection with such advantages over PLS as causing less trauma and a lower cost.