摘要
目的:对比分析常规腹腔镜与腹腔镜超声(LUS)下左半肝切除术围手术期相关指标、并发症情况及预后,为临床术式选择提供可借鉴依据。方法:选择2013年3月至2016年3月140例行左半肝切除术的原发性肝癌患者作为研究对象,按手术方法将患者分为观察组与对照组,每组70例。观察组在LUS下行左半肝切除术,对照组行常规腹腔镜左半肝切除术。对比两组围手术期指标、术后并发症及术后3年生存情况。结果:观察组术中出血量[(311.21±59.43)mL vs.(415.81±88.42)mL,t=8.215,P<0.001]少于对照组,术中肝中静脉损伤发生率(0 vs.14.29%,χ2=8.723,P=0.003)低于对照组。两组手术时间、病灶切缘距离、术后肛门首次排气时间、引流管拔管时间及术后并发症发生率差异均无统计学意义(P>0.05)。两组术后3年无进展生存率(45.71%vs.38.57%,χ2=0.732,P=0.392)、总生存率(64.29%vs.58.57%,χ2=0.482,P=0.487)差异均无统计学意义。结论:LUS与常规腹腔镜左半肝切除术治疗原发性肝癌的术后并发症、预后相近,但LUS有助于减少术中肝中静脉损伤及术中出血量。
Objective:To study the differences in perioperative parameters,complications and prognosis between conventional laparoscopic left hemihepatectomy and hemihepatectomy under laparoscopic ultrasound(LUS),and provide references for clinical operation selection.Methods:A total of 140 patients with primary liver cancer who received left hepatectomy from Mar.2013 to Mar.2016 were included as the objects.According to operation method,these patients were divided into observation group and control group with 70 cases in each group.The observation group received the left hemihepatectomy under LUS,the control group received routine laparoscopic hemihepatectomy.The perioperative parameters,the postoperative complications and the survival rate of the two groups during 3 years follow-up was compared.Results:The intraoperative blood loss of the observation group was significantly less than that of the control group[(311.21±59.43)mL vs.(415.81±88.42)mL,t=8.215,P<0.001],and the incidence of intraoperative middle hepatic vein injury of the observation group was significantly less than that of the control group[0(0.00%)vs.10(14.29%),χ2=8.723,P=0.003].There were no significant differences between the two groups in the operative time,the margin of tumorous incision,the first anal exhausting time,the extubation time of drainage tube and the incidence of postoperative complications(P>0.05).There were no significant differences in the progression-free survival rate and total survival rate at 3 years between the observation group and control group(45.71%vs.38.57%,χ2=0.732,P=0.392;64.29%vs.58.57%,χ2=0.482,P=0.487).Conclusions:The left hemihepatectomy under LUS have similar incidence of postoperative complications and prognosis for primary liver cancer comparing with routine laparoscopic hemihepatectomy,but the LUS can help to reduce middle hepatic vein injury and intraoperative bleeding.
作者
姚本来
姚立鹏
李晓明
邢福元
YAO Ben-lai;YAO Li-peng;LI Xiao-ming(Department of Hepatopancreatobiliary Surgery,Sanya People's Hospital of Hainan Province,Sanya 572000,China)
出处
《腹腔镜外科杂志》
2019年第11期809-813,共5页
Journal of Laparoscopic Surgery
关键词
肝肿瘤
左半肝切除术
腹腔镜检查
腹腔镜超声
疗效比较研究
Liver neoplasms
Left hepatectomy
Laparoscopy
Laparoscopic ultrasonography
Comparative effectiveness research
