本文關(guān)鍵詞： 腹腔鏡下肝切除術(shù) 開腹肝切除術(shù) 學(xué)習(xí)曲線　出處：《山東大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過腹腔鏡下肝切除術(shù)(laparoscopic hepatectomy, LH)與開腹肝切除術(shù)(open hepatectomy,OH)術(shù)中情況及術(shù)后恢復(fù)情況的比較與分析,評(píng)估早期LH的安全性及可行性,并為后期LH的開展提供參考。材料及方法：本研究收集了自2012年1月至2015年3月在山東省立醫(yī)院器官移植肝膽外二科實(shí)行肝切除術(shù)的84例患者的臨床資料,其中腹腔鏡肝切除術(shù)42例(LH組),開腹肝切除術(shù)42例(OH組),LH組肝臟病損包括良性疾病20例(47.6%),惡性疾病22例(52.4%),男女之比為11：10；OH組肝臟病損包括良性疾病17例(40.5%),惡性疾病25例(59.5%),男女之比為12：9。兩組患者需在年齡、病變位置和病變大小、術(shù)前肝功能Child-Pugh分級(jí)以及手術(shù)方式等方面處于同一水平,所有患者均不合并心肺腎等嚴(yán)重器質(zhì)性病變,手術(shù)均由相同年資的副高級(jí)以上醫(yī)師主刀完成�；仡櫺员容^和分析LH組和OH組患者的手術(shù)時(shí)間、術(shù)中失血量、術(shù)中輸血量、術(shù)中肝門阻斷率等術(shù)中情況以及術(shù)后肝功指標(biāo)、術(shù)后輸血量、術(shù)后3天腹腔引流量、并發(fā)癥發(fā)生率、術(shù)后進(jìn)食時(shí)間以及術(shù)后住院天數(shù)等術(shù)后恢復(fù)情況,總結(jié)與OH相比早期LH的優(yōu)勢(shì)和不足；分析LH組手術(shù)時(shí)間和術(shù)中失血量與手術(shù)方式和手術(shù)臺(tái)次(手術(shù)經(jīng)驗(yàn))的關(guān)系,并建立腹腔鏡肝切除術(shù)的學(xué)習(xí)曲線,為進(jìn)一步開展腹腔鏡手術(shù)提供參考。結(jié)果：84例患者手術(shù)過程順利,術(shù)后均恢復(fù)良好出院,無1例死亡。其中LH組與OH組相比,手術(shù)時(shí)間(225.6±83.3 vs 140.4±54.8)明顯延長,且有統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)中失血量(292.4±333.3 vs 286.9±218.9,P=0.93)及術(shù)中輸血量(257.1±557.0 vs 270.2±422.0,P=0.90)相仿,差異無統(tǒng)計(jì)學(xué)意義；術(shù)中肝門阻斷率(10.5%(4)vs 50%(21))降低,且有統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)后肝功ALT峰值(145.7±138.4 vs 243.0±199.8)降低,ALB低值(35.3±3.7 vs 32.7±4.7)升高,術(shù)后進(jìn)食時(shí)間(2.4±1.9 vs 3.5±1.8)縮短,術(shù)后住院天數(shù)(7.2±3.2 vs 10.0±3.5)減少,且均有統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)后3天平均腹腔引流量(147.0±155.6vs 127.7±170.4)、術(shù)后TBIL(23.2±10.8 vs 28.0±26.50)術(shù)后輸血量(161.0±422.0vs 202.4±503.7)、術(shù)后并發(fā)癥發(fā)生率(26.2% vs 23.8%)相仿,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。腹腔鏡下左半肝切除術(shù)手術(shù)時(shí)間較肝楔形切除和肝左外葉切除術(shù)手術(shù)時(shí)間明顯延長(266.7±78.7 vs 205.7±56.2,P0.05；266.7±78.7 vs 200.6±56.9,P=0.06),隨手術(shù)臺(tái)次的增加,腹腔鏡肝切除術(shù)手術(shù)時(shí)間逐漸縮短；腹腔鏡肝切除術(shù)術(shù)中失血量與手術(shù)方式無關(guān)(P0.05),隨手術(shù)臺(tái)次的增加,腹腔鏡肝切除術(shù)術(shù)中失血量逐漸減少。結(jié)論：手術(shù)經(jīng)驗(yàn)是影響腹腔鏡肝切除術(shù)術(shù)中操作的重要因素,隨手術(shù)經(jīng)驗(yàn)的積累,腹腔鏡肝切除術(shù)手術(shù)時(shí)間和術(shù)中出血量逐漸減少。與開腹肝切除術(shù)相比,腹腔鏡肝切除術(shù)手術(shù)創(chuàng)傷小、術(shù)后恢復(fù)快,但手術(shù)時(shí)間明顯延長。在嚴(yán)格把握手術(shù)適應(yīng)癥、熟練掌握腔鏡手術(shù)操作技術(shù)的前提下,腹腔鏡下肝切除術(shù)是安全可行和值得推廣的。
[Abstract]:Objective: to evaluate the safety and feasibility of laparoscopic hepatectomy (LHH) and open hepatectomy (OH) by comparing the operative and postoperative recovery of LHH and open hepatectomy. Materials and methods: from January 2012 to March 2015, the clinical data of 84 patients undergoing hepatectomy in two departments of organ transplantation outside bile duct of Shandong Provincial Hospital were collected. Laparoscopic hepatectomy was performed in 42 cases of LH group, open hepatectomy in 42 cases of liver lesions including benign diseases in 20 cases and malignant diseases in 22 cases. The ratio of male and female was 11: 10OH group, including 17 cases of benign diseases (17 cases), malignant diseases (17 cases) and malignant diseases (40. 5%). In 25 cases, the ratio of men to women was 12: 9.The two groups of patients had to be of age. The location and size of the lesion, the preoperative Child-Pugh grade of liver function and the operation mode were at the same level. All the patients were not complicated with serious organic diseases such as heart, lung and kidney. The operative time, blood loss, intraoperative blood transfusion, hepatic hilus occlusion rate and postoperative liver function of patients in LH group and OH group were retrospectively compared and analyzed, including the operation time, intraoperative blood loss, intraoperative blood transfusion, hepatic hilus occlusion rate and so on. After operation, the amount of blood transfusion, the volume of intraperitoneal drainage, the incidence of complications, the time of feeding after operation and the days of hospitalization after operation were all recovered. The advantages and disadvantages of early LH compared with OH were summarized. To analyze the relationship between the operation time and blood loss in LH group, the operation mode and the operating table (experience), and to establish the learning curve of laparoscopic hepatectomy. Results 84 patients underwent laparoscopic surgery, all of them recovered well, and no one died. The operative time in LH group was 225.6 鹵83.3 vs 140.4 鹵54.8, compared with that in OH group, and the operative time in LH group was significantly longer than that in OH group. The blood loss during operation was 292.4 鹵333.3 vs 286.9 鹵218.9P0.93) and the volume of blood transfusion was 257.1 鹵557.0 vs 270.2 鹵422.0P0.90). The peak value of ALT (145.7 鹵138.4 vs 243.0 鹵199.8) decreased the low value of ALB (35.3 鹵3.7 vs 32.7 鹵4.7), decreased the postoperative feeding time (2.4 鹵1.9 vs 3.5 鹵1.8), and decreased the postoperative hospitalization days (7.2 鹵3.2 vs 10.0 鹵3.5). The mean intraperitoneal drainage volume was 147.0 鹵155.6 vs 127.7 鹵170.4, TBIL(23.2 鹵10.8 vs 28.0 鹵26.50) the postoperative blood transfusion volume was 161.0 鹵422.0 vs 202.4 鹵503.7, and the incidence of postoperative complications was 26.2% vs 23.80.The mean postoperative intraperitoneal drainage volume was 147.0 鹵155.6 vs 127.7 鹵170.4, and the postoperative blood transfusion volume was 161.0 鹵422.0 vs 202.4 鹵503.7, respectively. The operative time of laparoscopic left hemihepatectomy was significantly longer than that of wedge-shaped hepatectomy and left lateral lobectomy (P 0.05266.7 鹵78.7 vs 205.7 鹵56.2P0.05266.7 鹵78.7 vs 200.6 鹵56.9). The amount of blood lost in laparoscopic hepatectomy is not related to the operative mode. With the increase of the operating table, the amount of blood loss in laparoscopic hepatectomy decreases gradually. Conclusion: the operative experience is an important factor affecting the operation of laparoscopic hepatectomy. With the accumulation of operative experience, the operative time and blood loss of laparoscopic hepatectomy gradually decreased. Compared with open hepatectomy, laparoscopic hepatectomy has less trauma and faster recovery after operation. But the operative time is obviously prolonged. Under the premise of strictly grasping the indication of operation and mastering the operative technique of endoscopic surgery, laparoscopic hepatectomy is safe, feasible and worth popularizing.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.3

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本文編號(hào)：1494347