腹腔镜与开腹肝切除术治疗肝癌的对比研究

目的探讨腹腔镜肝癌切除术的优越性。方法2012年1月～2013年12月，对原发性肝细胞肝癌行腹腔镜肝切除和开腹肝切除各22例，比较2组手术时间、术中出血量、术后排气时间、术后留置腹腔引流管时间、术后住院时间、手术费用、总费用、术后并发症。结果 与开腹手术相比，腹腔镜组术中出血量少（75．5±43．2）mlVS．（203．5±61．4）ml，t=－8．000，P=0．000]，手术时间短（121．3±31．5）ｍinVS．（141．4±32．2）min，t=－2．093，P=0．042]，排气早（31．2±0．9）hVS．（39．8±0．8）h，t=－33．500，P=0．000]，留置引流管时间短（4．1±2．1）dVS．（6．4±1．9）d，t=－3．810，P=0．000]，术后住院时间短（9．1±4．4）dVS．（11．6±3．1）d，t=－2．179，P=0．035]，但手术费用高（6815．3±2113．4）元VS．（3732．2±618．4）元，t=6．567，P=0．000]，2组并发症1例V８．3例，ｘ２=0．275，P=0．600]和总费用（14677．2±5444．3）元VS．（15123．3±4388．4）元，t=－0．299，P=0．766]差异无显著性。结论腹腔镜与开腹肝切除相比具有创伤小、痛苦少、术中出血少、术后恢复快、住院时间短等优越性。

A comparison Between Laparoscopic and Open Hepatectomy for Hepatocellular Carcinoma

Objective To evaluate the effectiveness of laparoscopic versus open surgery for liver cancer. Methods From January 2012 to December 2013, a series of 22 patients underwent open surgery （open group） and another group of 22 patients underwent laparoscopic gastrectomy （laparoscopic group） for the treatment of primary liver cancer. The related outcomes of the two groups were compared, which included operation time, intraoperative blood loss, postoperative exhaust time, indwelling drainage tube time, postoperative hospital stay, surgery cost, total cost, and postoperative complications. Results The laparoscopic group had significantly shorter intraoperative blood loss, surgical duration, postoperative exhaust time, indwelling drainage tube time, and postoperative hospital stay than those in the open group （75.5 ± 43.2） ml vs. （203.5 ± 61.4） ml, t = - 8. 000, P = 0. 000; （121.3±31.5） min vs. （141.4±32.2） min, t= -2.093, P=0.042; （31.2±0.9） hvs. （39.8±0.8） h, t= -33.500, P= 0.000; （4.1 ±2.1） d vs. （6.4±1.9） d, t = -3.810, P=O. 000; （9. 1 ±4.4） d vs. （11.6 ±3. 1） d, t = -2. 179, P= 0. 035 ]. However, the surgery cost was higher in the laparoscopic group than that in the open group （6815.3 ±2113.4） yuan vs. （3732.2±618.4） yuan, t = 6. 567, P = 0. 0001. No significant differences were detected in the total cost and postoperative complications between the two groups 1 patient vs. 3 patients, X3 = 0. 275, P = 0. 600 ; （ 14 677.2 ~ 5444.3） yuan vs. （ 15 123.3 ± 4388.4） yuan, t = - O. 299, P = 0. 766]. Conclusion Laparoscopic group is superior to open group in term of surgical invasion, patients＇ pain, intraoperative blood loss, postoperative recovery, and postoperative hospital stay.