腹腔镜与开腹肝切除术治疗肝脏疾病的疗效比较(1)
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[摘要] 目的:比较腹腔镜与开腹肝切除术治疗肝脏疾病的近期疗效。方法:将60例拟行肝切除术患者按患者意愿分为腹腔镜组和开腹组,各30例。比较两组患者的术中情况、术后恢复情况和并发症发生情况。结果:腹腔镜组患者的切口长度和手术时间明显短于开腹组,而术中出血量明显减少,腹腔镜组患者术后禁食时间、镇痛药物用量和住院时间明显少于开腹组,差异有统计学意义(P<0.01或P<0.05)。两组患者并发症总发生率差异无统计学意义(P>0.05)。结论:相对于开腹手术而言,腹腔镜肝切除术可明显改善患者术中和术后情况,且并不增加患者并发症发生的危险性。
[关键词] 腹腔镜;肝切除;对比研究
[中图分类号] R657.3[文献标识码]A [文章编号]1673-7210(2010)05(c)-030-03
Efficacy of laparoscopic and open hepatectomy on treatment of liver diseases
ZHANG Jinhui
(The First People′s Hospital of Baiyun District in Guangzhou City, Guangzhou 510410, China)
[Abstract] Objective: To explore the short-term efficacy of laparoscopic and open hepatectomy on the treatment of liver diseases. Methods: 60 patients scheduled for hepatectomy were divided into the laparoscopic group and open group according to the patients′ intentions, each 30 cases. A comparison was conducted in terms of intraoperative states, postoperative recovery status and incidence for complication between two groups. Results: The incision length was markedly shorter in the laparoscopic group than that in the open group, and the intraoperative blood loss and duration of surgery were much decreased, and the postoperative fasting time, analgesic drug usage and hospital stay were considerably less in the laparoscopic group than those in the open group, with significant differences between two groups (P<0.01 or P<0.05). There was no significant difference in total incidence rate for complication (P>0.05). Conclusion: Compared with open surgery, laparoscopic hepatectomy can significantly improve the intra- and post-operative states, without increasing the risk of complication incidence.
[Key words] Laparoscope; Hepatectomy; Comparative study
肝脏特有的解剖结构及生理特点使得腹腔镜肝切除成为技术复杂、难度极大的腹腔镜手术之一,发展缓慢,目前仍处于探索阶段[1]。随着腹腔镜技术的不断提高和手术经验的不断积累,腹腔镜肝切除术的临床报道不断增加[2]。本文中笔者通过比较腹腔镜与开腹肝切除术治疗肝脏疾病患者的术中情况、术后恢复情况和并发症发生情况,旨在进一步探讨腹腔镜肝切除术治疗肝脏疾病的可行性及临床疗效,为临床腹腔镜肝切除提供可行性指导。
1 资料与方法
1.1 一般资料
选择2008年6月～2009年6月入住我院普外科拟行肝段切除手术的患者60例,纳入标准:病变位于肝脏边缘(CouinaudⅡ、Ⅲ、Ⅳ、Ⅴ、Ⅵ段)或者位于肝脏表面,肿瘤仅局限于半肝范围内,病变大小不影响第一和第二肝门的解剖,良性病变≤15 cm,恶性肿瘤≤10 cm者;患者肝功能Child分级≥B级。排除标准:肝内胆管结石合并胆总管手术者;肝功能失代偿者;腹腔镜手术中转开腹者;心、脑和肾等重要脏器功能障碍者。按患者意愿将入选的60例患者分为腹腔镜组和开腹组,各30例。腹腔镜组:男11例,女19例;年龄33～70岁,平均(46 ......
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