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腹腔镜与开腹肝切除术治疗肝脏后上段肿瘤的病例对照研究

, PP. 2471-2475

Keywords: 腹腔镜,肝切除术,肝脏肿瘤,肝脏良性肿瘤

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Abstract:

目的探讨腹腔镜肝切除术治疗后上段肿瘤的安全性、可行性。方法回顾分析第三军医大学西南医院2009年1月-2013年1月手术治疗肝脏后上段肿瘤161例,其中腹腔镜肝切除58例(LLR组),开腹肝切除103例(OLR组)。结果两组间年龄、性别、病灶大小、Child-Pugh分级、病种分类、病灶位置、手术方式均无统计学差异;LLR组中转开腹率(5/58)8.62%,LLR组手术时间[(210.98±80.59)min,OLR组(230.51±67.01)min,P=0.101],无统计学差异;LLR组术中失血量[(271.55±226.92)mL,OLR组(451.94±365.21)mL,P<0.01],有显著统计学差异;输血率、R0切除率比较,P值分别为0.536、1.000,无统计学差异;术后住院时间LLR组[(9.98±4.40)d,OLR组(14.51±6.00)d,P<0.01],有显著统计学差异。LLR组与OLR组并发症总体发生率17.2%、46.6%,(P=0.000),有显著统计学差异,良性疾病病例无复发,恶性肿瘤病例复发率为30.56%、34.21%,P=0.701,无统计学差异;LLR组与OLR组1年生存率分别为94.44%、88.16%,P=0.498,1年无瘤生存率分别为88.89%、80.26%,P=0.256。LLR组与OLR组3年生存率分别为83.33%、69.74%,P=0.498,3年无瘤生存率分别为69.44%、65.79%,P=0.701,均无统计学差异。结论腹腔镜肝切除治疗后上段肿瘤安全、有效,同时具有术中出血、术后并发症少,以及术后住院时间短的优势。

References

[1]  Abu-Hilal M, Di-Fabio F, Teng M J,et al. Single-centre comparative study of laparoscopic versus open right hepatectomy[J]. J Gastrointest Surg, 2011, 15(5): 818-823. [2]Ai J H, Li J W, Chen J,et al. Feasibility and safety of laparoscopic liver resection for hepatocellular carcinoma with a tumor size of 5-10cm[J]. PLoS One, 2013, 8(8): e72328. [3]郑树国, 李建伟, 陈健, 等. 腹腔镜肝切除术临床应用的经验体会[J]. 中华肝胆外科杂志, 2011, 17(8): 614-617. [4]Nguyen K T, Marsh J W, Tsung A,et al. Comparative benefits of laparoscopic ?vs? open hepatic resection: a critical appraisal[J]. Arch Surg, 2011, 146(3): 348-356. [5]Croome K P, Yamashita M H. Laparoscopic vs open hepatic resection for benign and malignant tumors: An updated meta-analysis[J]. Arch Surg, 2010, 145(11): 1109-1118. [6]Buell J F, Cherqui D, Geller D A,et al. The international position on laparoscopic liver surgery: The Louisville Statement, 2008[J]. Ann Surg, 2009, 250(5): 825-830. [7]Cherqui D, Husson E, Hammoud R,et al. Laparoscopic liver resections: a feasibility study in 30 patients[J]. Ann Surg, 2000, 232(6): 753-762. [8]Dagher I, Proske J M, Carloni A,et al. Laparoscopic liver resection: results for 70 patients[J]. Surg Endosc, 2007, 21(4): 619-624. [9]郑树国. 腹腔镜技术在肝脏外科的拓展应用[J]. 中华消化外科杂志, 2013, 12(5): 324-327 [10]Yoon Y S, Han H S, Choi Y S,et al. Total laparoscopic right posterior sectionectomy for hepatocellular carcinoma[J]. J Laparoendosc Adv Surg Tech A, 2006, 16(3): 274-277. [11]Yoon Y S, Han H S, Cho J Y,et al. Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver[J]. Surg Endosc, 2010, 24(7): 1630-1637. [12]Kazaryan A M, Rosok B I, Marangos I P,et al. Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments[J]. Surg Endosc, 2011, 25(12): 3881-3889. [13]Cho J Y, Han H S, Yoon Y S,et al. Experiences of laparoscopic liver resection including lesions in the posterosuperior segments of the liver[J]. Surg Endosc, 2008, 22(11): 2344-2349. [14]Slakey D P, Simms E, Drew B,et al. Complications of liver resection: laparoscopic versus open procedures[J]. JSLS, 2013, 17(1): 46-55. [15]Sarpel U, Hefti M M, Wisnievsky J P,et al. Outcome for patients treated with laparoscopic versus open resection of hepatocellular carcinoma: case-matched analysis[J]. Ann Surg Oncol, 2009, 16(6): 1572-1577. [16]Cho J Y, Han H S, Yoon Y S,et al. Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overco ming current limitations on tumor location[J]. Surgery, 2008, 144(1): 32-38. [17]Araki K, Conrad C, Ogiso S,et al. Intraoperative ultrasonography of laparoscopic hepatectomy: key technique for safe liver transection[J]. J Am Coll Surg, 2014, 218(2): e37-e41. [18]Shi M, Guo R P, Lin X J,et al. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: a prospective randomized trial[J]. Ann Surg, 2007, 245(1): 36-43. [19]Hamady Z Z, Cameron I C, Wyatt J,et al. Resection margin in patients undergoing hepatectomy for colorectal liver metastasis: a critical appraisal of the 1 cm rule[J]. Eur J Surg Oncol, 2006, 32(5): 557-563. [20]Matsui Y, Terakawa N, Satoi S,et al. Postoperative outcomes in patients with hepatocellular carcinomas resected with exposure of the tumor surface: clinical role of the no-margin resection[J]. Arch Surg, 2007, 142(7): 596-603. [21]Ikai I, Arii S, Kojiro M,et al. Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey[J]. Cancer, 2004, 101(4): 796-802. ?
[2]  朱新生,章跃民,李柏红,等.部分肝血流阻断器在腹腔镜肝切除术中的应用[J].第三军医大学学报,2007,29(14):1447. [2]宋晓雪,谢炜,孙安仁,等.肝切除术治疗肝胆管结石的临床疗效观察[J].第三军医大学学报,2006,28(16):1732. [3]曹永,谭平,郑树国.21例腹腔镜肝切除术的围手术期护理[J].第三军医大学学报,2009,31(12):1154. [4]赵江宁,谭志健,张思奋.同时性大肠癌肝转移腹腔镜一期手术切除8例临床分析[J].第三军医大学学报,2009,31(17):1702. [5]宋晓雪,谢炜,孙安仁,等.肝癌合并胆管内癌栓的诊断与治疗效果[J].第三军医大学学报,2006,28(14):1514. [6]郑培秋,何艳英.T管引流术预防肝吸虫病肝切除术后胆漏的临床观察[J].第三军医大学学报,2010,32(16):1776.

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