完全腹腔镜下左肝部分切除术与开放手术的临床应用比较

摘要

Objective To analyze the clinical effect of laparoscopic left partial hepatectomy versus that of open surgery.Methods 102 patients with liver cancer treated at our hospital from July,2014 to July,2015 were selected and were divided into an observation group and a control group according to the surgical methods,51 cases for each group.The observation group were treated with laparoscopic left partial hepatectomy and the control group open surgery.The intra-and post-operative conditions,liver function indicators,post-operative complications,and so on were compared between these two groups.Results The intra-operative bleeding volume,flatus time,and hospital stay were (175±58) ml,(1.2±0.3) d,and (6.2±1.0) d in the observation group and were (302±117) ml,(3.4±0.5) d,and (12.3±2.2) in the control group,with statistical differences (P ＜ 0.05).There were no statistical differences in operation time and hospitalization cost between these two groups.1 day after the operation,the levels of AST,ALT,and total bilirubin were (50.12 ± 15.21) IU/L,(50.31 ± 25.52) IU/L,and (12.33 ± 5.40) μ mol/L in the operation group and were (88.14 ± 21.60) IU/L,(125.30 ± 55.46) IU/L,and (75.90 ± 10.22) μmol/L in the control group,with statistical differences (t=3.426,P ＜ 0.05).Conclusions Laparoscopic left partial hepatectomy for cancer of left liver can effectively reduce intra-operative bleeding volume,decrease the incidence of post-operative complications,shorten flatus time and hospital stay,and recover the patients' liver function indicators and is safe,so it is being clinically generalized.%目的 比较分析完全腹腔镜下左肝部分切除术与开放手术的临床应用效果.方法 本文研究对象选自本院2014年7月至2015年7月收治的102例左肝肿瘤患者,根据手术方法将其分为观察组和对照组,每组51例;给予观察组患者实施完全腹腔镜下左肝部分切除术,对照组患者实施开放手术,对比两组患者术中术后、肝功能指标恢复及术后并发症等情况.结果 观察组患者术中出血量为(175±58)ml,对照组术中出血量为(302± 117) ml,两组对比差异有统计学意义(P＜0.05).观察组术后肛门排气时间为(1.2±0.3)天、住院时间为(6.2±1.0)天,均短于对照组排气时间的(3.4±0.5)天和住院时间的(12.3±2.2)天;两组手术时间、住院费用对比差异无统计学意义(P＞0.05).观察组术后第1天AST为(50.12±15.21) IU/L,ALT为(50.31±25.52) IU/L,总胆红素为(12.33±5.40)μmol/L,对照组术后第1天AST为(88.14±21.60) IU/L,ALT为(125.30±55.46) IU/L,总胆红素为(75.90±10.22)μmol/L;观察组的谷草转氨酶(AST)、谷丙转氨酶(ALT)和总胆红素水平明显优于对照组,两组对比差异有统计学意义(t=3.426,P＜0.05).结论 完全腹腔镜下左肝部分切除术治疗左肝肿瘤能有效减少患者术中出血量,术后并发症少,排气和住院时间短,患者肝功能指标恢复速度快,安全性较高,值得临床推广和应用.