本文選題：肝切除術(shù) + 腹腔鏡��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：研究目的腹腔鏡肝切除經(jīng)過20余年的發(fā)展,應(yīng)用日漸成熟,由肝邊緣腫塊切除逐漸發(fā)展為解剖性肝段、肝葉及半肝切除。本文旨在通過腹腔鏡肝切除術(shù)(Laparoscopic Hepatectomy,LH)與開腹肝切除術(shù)(Open Hepatectomy,OH)的短期療效、住院費(fèi)用對比研究,探討腹腔鏡肝切除術(shù)的安全性、可行性、微創(chuàng)性及社會價值,并通過不同亞組分析以優(yōu)選出更適合行腹腔鏡肝切除的病例類型。研究方法回顧性分析本中心2011年6月至2014年9月間行肝切除術(shù)的臨床資料,按手術(shù)方式分為腹腔鏡肝切除術(shù)組(LH組)、開腹肝切除術(shù)組(OH組)。對比分析兩種手術(shù)方法在手術(shù)情況、術(shù)后恢復(fù)及住院費(fèi)用,并對肝硬化、腫瘤、肝膽管結(jié)石、再次手術(shù)及Ⅱ-Ⅲ段切除的病例分別進(jìn)行亞組分析。結(jié)果 本組總共142例,男性73例,女性69例,年齡21-80歲,平均54.90歲。其中LH組66例,OH組76例。兩組在性別、年齡、BMI指數(shù)、ASA麻醉分級、肝功能Child-Pugh分級、合并癥、手術(shù)切除部位上無統(tǒng)計(jì)學(xué)差異。與OH組相比,LH組手術(shù)時間短(151.71±64.81vs.206.45±69.02min,P0.01),術(shù)中出血量少(111.82±87.56 vs.307.89±236.37ml,P0.01),術(shù)后肛門排氣時間短(2.33±0.69 vs.3.96± 1.01 天,P0.01),進(jìn)食時間早(1.68±0.79 vs.2.21±0.70 天,P0.01),術(shù)后住院時間短(7.21±3.42vs.13.72±9.16天,P0.01),并發(fā)癥相較少且輕(9.09%vs.26.32%P0.01),住院總費(fèi)用少(41041.67±14005.19 vs.48251.84±23266.53 元,P=0.03)。兩組患者在術(shù)后第 1、3、5 天的 ALT、AST、ALB、TBIL、WBC、HB、DBIL、Ne%、HsCRP數(shù)值比較,波動幅度及恢復(fù)速度的差異有統(tǒng)計(jì)學(xué)意義(P0.05)。腫瘤、肝膽管結(jié)石、Ⅱ-Ⅲ段切除亞組分析,LH組在手術(shù)時間、術(shù)中出血量、術(shù)后恢復(fù)情況及住院費(fèi)用上,均優(yōu)于OH組(P0.05);而對于肝硬化、再次手術(shù)的亞組,效果就不如其他3個亞組明顯,這兩個亞組在手術(shù)時間、開始進(jìn)食天數(shù)、并發(fā)癥、住院費(fèi)用上均無統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論 腹腔鏡肝切除術(shù)是安全可行的,有手術(shù)時間短、術(shù)中出血量少、術(shù)后恢復(fù)快及住院費(fèi)用低等優(yōu)勢,尤其適用于肝臟腫瘤、肝膽管結(jié)石、Ⅱ-Ⅲ段切除患者。
[Abstract]:Objective Laparoscopic hepatectomy has been developed for more than 20 years, and it has been used maturely. The resection of marginal masses of liver developed into anatomical liver segment, liver lobes and hemihepatectomy.The purpose of this study was to investigate the safety, feasibility, minimally invasive and social value of laparoscopic hepatectomy (LC) and open hepatectomy (OH).Different subgroups were analyzed to select the more suitable cases for laparoscopic hepatectomy.Methods the clinical data of hepatectomy from June 2011 to September 2014 were retrospectively analyzed. The patients were divided into laparoscopic hepatectomy group (LH group) and open hepatectomy group (OH group).The patients with cirrhosis, tumor, hepatolithiasis, reoperation and 鈪，

本文編號：1751378