腹腔镜解剖性肝切除与常规开腹肝切除术治疗肝包虫病的疗效分析

摘要

Objective To analyze the efficacy of laparoscopic anatomical hepatectomy and conventional open hepatectomy in the treatment of hepatic echinococcosis.Methods One hundred and thirty patients with hepatic echinococcosis admitted to our hospital from September 2015 to June 2017 were selected and divided into the experimental group (laparoscopic anatomical hepatectomy,n =60) and the control group(conventional open hepatectomy,n = 70) according to the random blind method.The patients were followed up for 6 months after operation.The general situation,the pain visual analogue scale (VAS) before and after operation,the hepatic re-serve function parameters such as standard remnant liver volume(SRLV),alanine aminotransferase(ALT),and gamma glutamyl trans-ferase (GGT) were compared between the two groups.The recurrence and complications were also observed.Results The operative time,hospital stay and postoperative extubation time in the experimental group were shorter than those in the control group,and the intr-aoperative blood loss was lower than that in the control group(P < 0.01).The VAS scores in the experimental group after 1 week and 2 weeks of operation were significantly lower than those in the control group(P<0.01).The level of postoperative SRLV in the experi-mental group was significantly higher while the serum levels of ALT and GGT were lower than those in the control group(P < 0.01). No recurrence occurred in the two groups after operation,and the incidence of complications after 6 months of operation in the experi-mental group was lower than that in the control group(P < 0.05).Conclusion Compared with conventional open hepatectomy,lapa-roscopic anatomical hepatectomy in the treatment of hepatic echinococcosis has better efficacy,and can reduce the surgical trauma and promote the postoperative recovery.It can retain liver reserve function well and has few postoperative complications.Therefore,it is wor-thy of clinical promotion and practice.%目的 分析腹腔镜解剖性肝切除与常规开腹肝切除术治疗肝包虫病的临床疗效.方法 选取2015年9月至2017年6月我院收治的肝包虫病患者130例,采用盲法随机分为试验组(腹腔镜解剖性肝切除术,n=60)与对照组(常规开腹肝切除术,n=70),术后随访6个月,记录比较两组手术一般情况及手术前后疼痛视觉模拟评分(VAS)、肝储备功能参数[标准残肝体积(SRLV)、谷丙转氨酶(ALT)、γ-谷氨酰转肽酶(GGT)],观察复发及并发症情况.结果 试验组手术时间、住院时间、术后拔管时间短于对照组,而术中出血量低于对照组(P<0.01);试验组术后1周、2周VAS评分明显低于对照组(P<0.01);试验组术后SRLV大于对照组,而血清ALT、GGT低于对照组(P<0.01);术后两组均无1例复发,试验组术后6个月并发症发生率低于对照组(P<0.05).结论 与常规开腹肝切除术相比,腹腔镜解剖性肝切除术治疗肝包虫病疗效较好,可减少手术创伤、促进术后康复,同时较好保留肝储备功能,术后并发症少,值得在临床推广实践.