本文選題：腹腔鏡肝切除 + 開腹肝切除��； 參考：《瀘州醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的：本文通過(guò)對(duì)腹腔鏡肝切除與開腹肝切除術(shù)就手術(shù)及其術(shù)后療效作一比較,進(jìn)而肯定腹腔鏡肝切除術(shù)對(duì)于治療肝臟腫瘤的臨床應(yīng)用價(jià)值,用以評(píng)價(jià)腹腔鏡肝切除的安全性及可行性,及其與開腹肝切除術(shù)相比所體現(xiàn)出的優(yōu)越性與不足。方法：根據(jù)本研究中病例選擇的納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),收集了宜賓市第一人民醫(yī)院普外科自2010年1月～2012年1月的45例患者的臨床資料。根據(jù)手術(shù)方式分為腹腔鏡(LH, Laparoscopic hepatectomy)組和開腹(OH, Open hepatectomy)組。觀察和比較兩組患者的一般資料、手術(shù)時(shí)間、術(shù)中出血量、輸血情況、肝門阻斷與否、術(shù)后住院天數(shù)、術(shù)后鎮(zhèn)痛藥物的使用、術(shù)后攜帶胃管時(shí)間、術(shù)后攜帶引流管的時(shí)間；術(shù)后并發(fā)癥；術(shù)后生存狀況等指標(biāo)。采用定期的門診隨訪、電話隨訪或醫(yī)護(hù)人員上門隨訪相結(jié)合的隨訪方式,建立統(tǒng)一、齊全的數(shù)據(jù)庫(kù)資料,詳細(xì)登記患者術(shù)后的恢復(fù)情況,以及術(shù)后并發(fā)癥的發(fā)生情況。結(jié)果：腹腔鏡組與開腹組在年齡、性別、肝功能分級(jí)、根據(jù)腫瘤的位置所選擇的切除方式、病灶直徑、病變分類、病變部位等臨床病理學(xué)特征上差異無(wú)顯著性(P值0.05)。腹腔鏡組手術(shù)時(shí)間為189.35±13.94(min)、術(shù)中出血量為517.83±69.74(m1)、輸血2例、阻斷肝門血流4例；開腹組手術(shù)時(shí)間為164.23±20.90(min)、術(shù)中出血量為612.27±41.85(m1)、輸血8例、阻斷肝門血流10例。腹腔鏡組與開腹組手術(shù)時(shí)間比較P值0.05,兩組在手術(shù)時(shí)間方面無(wú)明顯統(tǒng)計(jì)學(xué)差異；腹腔鏡組與開腹組在術(shù)中出血、是否輸血、是否阻斷肝門方面比較皆P值0.05,差異具有統(tǒng)計(jì)學(xué)意義。腹腔鏡組與開腹組在術(shù)后并發(fā)癥中腹腔出血、肺部感染、膽漏、切口感染、腹腔積液、腹腔感染、胸腔積液等比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。腹腔鏡組與開腹組在術(shù)后并發(fā)癥總例數(shù)比較差異亦無(wú)統(tǒng)計(jì)學(xué)意義(X2=1.171,P=0.279)。腹腔鏡組存活中位數(shù)為26.70±0.92(月),開腹組存活中位數(shù)為24.33±0.83(月),兩組比較無(wú)顯著性差異(P=0.857),腹腔鏡肝切除與開腹肝切除術(shù)對(duì)術(shù)后生存無(wú)顯著差別。結(jié)論：腹腔鏡及開腹肝切除術(shù)對(duì)于治療肝臟良惡性腫瘤均具有良好的效果,具有可行性,但腹腔鏡肝切除術(shù)具有腹壁切口小、術(shù)后使用鎮(zhèn)痛藥物少、術(shù)后恢復(fù)快、住院時(shí)間短等優(yōu)越性。因此,經(jīng)過(guò)完善的術(shù)前評(píng)估、病例選擇合適的前提下,肝臟良惡性腫瘤患者行腹腔鏡肝切除術(shù)是微創(chuàng)、安全的、可行的,并在術(shù)后恢復(fù)方面腹腔鏡肝切除較開腹肝切除術(shù)有其獨(dú)特的優(yōu)勢(shì)。
[Abstract]:Objective: to evaluate the clinical value of laparoscopic hepatectomy (LC) in the treatment of liver tumors by comparing the results of laparoscopic hepatectomy and open hepatectomy. To evaluate the safety and feasibility of laparoscopic hepatectomy and its advantages and disadvantages compared with open hepatectomy. Methods: according to the inclusion and exclusion criteria of case selection in this study, the clinical data of 45 patients in general surgery of Yibin first people's Hospital from January 2010 to January 2012 were collected. According to the operation mode, the patients were divided into two groups: laparoscopy group (LH group), Laparoscopic group and Open group (OH group). The general data, operative time, intraoperative blood loss, blood transfusion, hepatic hilus occlusion, postoperative hospitalization days, postoperative analgesic drug use, postoperative gastric tube carrying time and postoperative drainage tube were observed and compared between the two groups. Postoperative complications, postoperative survival status and other indicators. By means of regular out-patient follow-up, telephone follow-up or in-door follow-up of medical staff, a unified and complete database was established to record the recovery of patients after operation and the occurrence of postoperative complications. Results: there was no significant difference in age, sex, liver function grade, tumor location, lesion diameter, lesion classification, pathological location and other clinicopathological features between laparoscopy group and laparotomy group (P = 0.05). In the laparoscopy group, the operative time was 189.35 鹵13.94 min, the intraoperative blood loss was 517.83 鹵69.74 m ~ (-1), blood transfusion was performed in 2 cases, and the hepatic portal blood flow was blocked in 4 cases, the operative time in the open group was 164.23 鹵20.90 min, the intraoperative bleeding volume was 612.27 鹵41.85 m ~ (-1), the blood transfusion was in 8 cases, and the hepatic portal blood flow was blocked in 10 cases. There was no significant difference in the operative time between the laparoscopic group and the laparotomy group, the bleeding and blood transfusion were observed in the laparoscopic group and the open group. There was a significant difference in P value of 0.05 for hepatic hilus occlusion. There was no significant difference between laparoscopy group and laparotomy group in abdominal cavity hemorrhage, pulmonary infection, bile leakage, incision infection, peritoneal effusion, abdominal infection, pleural effusion and so on. There was no significant difference in the total postoperative complications between the laparoscopic group and the open group. The median survival of laparoscopy group was 26.70 鹵0.92 (month), and that of open group was 24.33 鹵0.83. There was no significant difference between the two groups. There was no significant difference between laparoscopic hepatectomy and open hepatectomy in postoperative survival. Conclusion: both laparoscopic and open hepatectomy are effective and feasible in the treatment of benign and malignant liver tumors. However, laparoscopic hepatectomy has small abdominal incision, less analgesic drugs after operation, and quick recovery after operation. The advantage of short hospital stay. Therefore, laparoscopic hepatectomy is minimally invasive, safe and feasible for patients with benign and malignant tumors of the liver. Laparoscopic hepatectomy has a unique advantage over open hepatectomy in postoperative recovery.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.7

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