腹腔镜与开腹肝左外叶切除术的比较

目的探讨腹腔镜肝左外叶切除术的可行性、安全性及临床疗效。方法回顾性分析2008年6月～2012年7月我科20例腹腔镜下肝左外叶切除术（腹腔镜组）与20例开腹肝左外叶切除术（开腹组）的临床资料,比较2组手术时间、术中出血量、术后住院时间、术后并发症、住院总费用和复发率。结果 2组均顺利完成肝左外叶切除术。腹腔镜组手术时间（99.3±20.3）min vs.（150.3±28.4）min,t=-6.533,P=0.000],术中出血量（85.5±48.2）ml vs.（146.5±48.8）ml,t=-3.978,P=0.000],术后住院时间（6.2±1.4）d vs.（11.1±3.8）d,t=-5.411,P=0.000]均与开腹组有统计学差异;2组住院总费用、术后并发症发生率均无统计学差异（2.15±0.17）万元vs.（2.13±0.22）万元,t=0.322,P=0.749;0 vs.5.0%（1/20）,P=0.500]。22例肝癌（腹腔镜组12例,开腹组10例）随访时间3～24个月,平均18个月,4例（腔镜组和开腹组各2例）术后14～23个月经CT检查证实为肿瘤复发,腹腔镜组和开腹组的复发率分别为16.7%（2/12）、20.0%（2/10）,2组复发率无统计学差异（P=0.632）。结论腹腔镜肝左外叶切除术是可行、安全的,与开腹肝左外叶切除术比较,具有微创、术后恢复快等优势。

Laparoscopic versus Open Left Lateral Segment Liver Resection： A Clinical Comparative Study

Objective To explore the feasibility, safety and clinical efficacy of laparoscopic left lateral segment liver resection. Methods The clinical data of 20 patients who received laparoseopic left lateral segment liver resection （laparoscopic group） were retrospectively compared with 20 patients who received open left lateral segment liver resection （open group） from June 2008 to July 2012. The duration of operation, intraoperative blood loss, hospital stay, postoperative complications, total hospital cost and the rate of recurrence were compared respectively. Results Left lateral segment liver resection was performed successfully in both the laparoseopic group and the open group. The duration of operation, intraoperative blood loss and postoperative hospital stay in the laparoseopie group were significantly different from those of the open group： （99.3 ±20.3 ） rain vs. （ 150.3 ± 28.4） min, t = -6. 533,P=0.000;（85.5±48.2）ml vs （146.5 ±48.8）ml, t = -3.978,P =0.000;（6.2 ±1.4）d vs （11.1 ±3.8）d, t = -5. 411 ,P = 0. 000]. No significant difference was observed in the incidence of postoperative complications and total hospital cost （2.15 ±0.17） ×104 yuan vs. （ 2.13 ±0.22） x104 yuan,t=0.322,P=0.749;0 vs. 5.0% （1/20）,P=0.5001. Among the cases studied, 22 patients with hepatic cancer（ 12 in laparoseopic group, 10 in open group） were followed up for 3 -24 months with an average of 18 months and 4 patients（2 in laparoseopic group,2 in open group） had recurrent hepatic cancer, which was confirmed by CT. The rate of recurrence was 16.7% （laparoseopie group） and 20.0% （open group） respectively, and no significant difference was found between the two groups（P = 0. 632）. Conclusions Laparoscopic left lateral segment liver resection is feasible and safe. Compared with open left lateral segment liver resection, it has the advantages of less trauma, quicker recovery and better overall efficacy.