腹腔镜与开腹用于半肝切除近期疗效比较:一项倾向性评分匹配分析

目的在匹配良好的情况下比较腹腔镜与开腹半肝切除的安全性及近期疗效。方法回顾性分析2012年1月至2018年9月期间在南方医科大学南方医院肝胆外科261例因良恶性疾病行左半肝或右半肝切除术病人的临床资料,其中43例行腹腔镜半肝切除(腹腔镜组),218例行开腹半肝切除(开腹组)。使用包括手术切除范围、手术时期、病人基本特征和肿瘤最大直径等对腹腔镜组和开腹组进行1∶4倾向性评分匹配(PSM),比较匹配后两组的围手术期相关临床数据。结果138例病人匹配成功,其中腹腔镜组36例,开腹组102例。两组手术切除范围、手术时期、病人的基本特征和肿瘤最大直径等9个混杂因素达到平衡。腹腔镜组较开腹组结果数据以M(P25,P75)表示]出血量少200(100,200)ml比300(200,400)ml,P<0.05],输血量少0(0,0)ml比0(0,400)ml,P<0.05],术后禁食天数1.00(1.00,2.00)d比3.00(2.00,4.00)d,P<0.05]及术后住院天数8.38(7.00,10.00)d比11.85(9.38,14.38)d,P<0.05]更短。腹腔镜组较开腹组输血率低(11.1%比34.3%,P<0.05)。腹腔镜组术后第1天、第5天白细胞计数(WBC)水平低于开腹组(P<0.05)。但腹腔镜组手术时间更长(317.42±86.58)min比(248.92±91.54)min,P<0.05],住院总费用更高(7.75±1.44)万元比(6.47±1.84)万元,P<0.05]。两组术后并发症发生率、严重程度,术后肝功能不全发生率及严重程度,术后第1、3、5天的红细胞计数(RBC)、血红蛋白(Hb)、血小板计数(PLT)、血清白蛋白(ALB)、丙氨酸转氨酶(ALT)、总胆红素(TBIL)、直接胆红素(DBIL)水平差异均无统计学意义(均P>0.05)。结论腹腔镜半肝切除术治疗肝脏良恶性疾病安全可行,其术中出血量更少,病人术后恢复更快。

Comparison of short-term efficacy between laparoscopy and laparotomy in hemihepatic resection:apropensity score matching analysis

Objective To compare the short-term efficacy of laparoscopic and open hemihepatic resection between well-matched patient groups.Methods The clinical data of 261 patients who underwent left or right hemihepatectomy for benign and malignant diseases in the Department of Hepatobiliary Surgery,Nanfang Hospital,Southern Medical University,Guangdong Province from January 2012 to September 2018 were retrospectively analyzed,in which 43 patients underwent laparoscopic hemihepatectomy(laparoscopic group)and 218 patients underwent open hemihepatectomy(open group).Perioperative clinical data were compared between the two groups after 1∶4 propensity score matching(PSM)based on the factors including extent of surgical resection,duration of surgery,patient characteristics,and maximum tumor diameter.Results 138 patients were successfully matched,including 36 cases in laparoscope group and 102 cases in laparotomy group.Nine confounding factors,including the extent of surgical resection,the duration of surgery,the basic characteristics of the patients,and the maximum diameter of the tumor,were balanced between the two groups.The blood loss200(100,200)ml vs.300(200,400)ml,P<0.05],blood transfusion rate(11.1 vs.34.3)%,P<0.05]and blood transfusion volume0(0,0)ml vs.0(0,400)ml,P<0.05]in laparoscopic group were smaller than those in laparotomy group,and the postoperative fasting days1.00(1.00,2.00)d vs.3.00(2.00,4.00)d,P<0.05]and postoperative hospital stay8.38(7.00,10.00)d vs.11.85(9.38,14.38)d,P<0.05]were shorter.The WBC level in laparoscope group was lower than that in laparotomy group on postoperative d1 and d5,P<0.05.However,the operation time in the laparoscopic group was longer(317.42±86.58)min vs.(248.92±91.54)min,P<0.05],and the total hospitalization cost was higher(7.75±1.44)ten thousand yuan vs.(6.47±1.84)ten thousand yuan,P<0.05].The incidence and severity of postoperative complications,the incidence and severity of postoperative liver insufficiency,and the levels of RBC,Hb,PLT,ALB,ALT,TBIL and DBIL at 1,3 and 5 days after surgery show no difference between the two groups(P>0.05).Conclusion Laparoscopic hemihepatectomy is a safe and feasible treatment for benign and malignant liver diseases with less intraoperative blood loss and faster postoperative recovery.