目的比较腹腔镜和开腹肝切除术在具有伴发疾病的老年肝脏恶性肿瘤患者中的疗效和短期获益。方法纳入自2015年4—10月期间因肝脏恶性肿瘤接受肝切除的70岁及以上患者。17例腹腔镜手术患者的围手术期结果按照1∶2的比例与传统开腹手术患...目的比较腹腔镜和开腹肝切除术在具有伴发疾病的老年肝脏恶性肿瘤患者中的疗效和短期获益。方法纳入自2015年4—10月期间因肝脏恶性肿瘤接受肝切除的70岁及以上患者。17例腹腔镜手术患者的围手术期结果按照1∶2的比例与传统开腹手术患者相匹配。结果两组患者的年龄、性别、合并症发病率、乙型肝炎阳性率,肝功能Child评分无统计学差异。两组中位肿瘤大小均为3 cm。两组之间肝切除类型相似,手术时间无明显差异(腹腔镜195 min vs.开腹210 min,P=0.436)。腹腔镜组围手术期失血量为150 m L,开腹组为330 m L,差异无统计学意义(P=0.046)。腹腔镜组平均住院时间为6 d(3~15 d),开腹组为8 d(5~105 d)(P=0.005)。结论腹腔镜肝切除术对老年患者是安全可行的。腹腔镜手术的短期获益在老年患者肝脏肿瘤手术中仍然显见。展开更多
Epidural analgesia has long been regarded as the gold standard in abdominal surgery. However, concerns regarding risks associated with central neuraxial blockade, catheter placement and the presence of coagulopathy in...Epidural analgesia has long been regarded as the gold standard in abdominal surgery. However, concerns regarding risks associated with central neuraxial blockade, catheter placement and the presence of coagulopathy in patients undergoing liver resection have limited its use. Bilateral erector spinae plane blocks and catheter placement may mimic the effects of epidural analgesia by blocking both somatic and visceral pain while concomitantly avoiding central neuraxial blockade and catheter placement. We describe our experience in using the erector spinae plane block and catheter placement as part of a multimodal analgesia approach in a patient undergoing laparoscopic and another patient undergoing open liver resection. Our findings concur with previous reports which suggest that erector spinae plane blocks may be more efficacious as somatic rather than visceral analgesia. However, we conclude that further studies on factors affecting its efficacy should be conducted in view of the present lack of researched evidence.展开更多
文摘目的比较腹腔镜和开腹肝切除术在具有伴发疾病的老年肝脏恶性肿瘤患者中的疗效和短期获益。方法纳入自2015年4—10月期间因肝脏恶性肿瘤接受肝切除的70岁及以上患者。17例腹腔镜手术患者的围手术期结果按照1∶2的比例与传统开腹手术患者相匹配。结果两组患者的年龄、性别、合并症发病率、乙型肝炎阳性率,肝功能Child评分无统计学差异。两组中位肿瘤大小均为3 cm。两组之间肝切除类型相似,手术时间无明显差异(腹腔镜195 min vs.开腹210 min,P=0.436)。腹腔镜组围手术期失血量为150 m L,开腹组为330 m L,差异无统计学意义(P=0.046)。腹腔镜组平均住院时间为6 d(3~15 d),开腹组为8 d(5~105 d)(P=0.005)。结论腹腔镜肝切除术对老年患者是安全可行的。腹腔镜手术的短期获益在老年患者肝脏肿瘤手术中仍然显见。
文摘Epidural analgesia has long been regarded as the gold standard in abdominal surgery. However, concerns regarding risks associated with central neuraxial blockade, catheter placement and the presence of coagulopathy in patients undergoing liver resection have limited its use. Bilateral erector spinae plane blocks and catheter placement may mimic the effects of epidural analgesia by blocking both somatic and visceral pain while concomitantly avoiding central neuraxial blockade and catheter placement. We describe our experience in using the erector spinae plane block and catheter placement as part of a multimodal analgesia approach in a patient undergoing laparoscopic and another patient undergoing open liver resection. Our findings concur with previous reports which suggest that erector spinae plane blocks may be more efficacious as somatic rather than visceral analgesia. However, we conclude that further studies on factors affecting its efficacy should be conducted in view of the present lack of researched evidence.
