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

【摘要】：目的:隨著科技的進(jìn)步,外科領(lǐng)域手術(shù)器械和手術(shù)方式的不斷革命和創(chuàng)新,使得微創(chuàng)外科取得的長足的進(jìn)步。微創(chuàng)技術(shù)深入到了每一個(gè)外科領(lǐng)域,腹腔鏡下肝切除術(shù)(Laparoscopic hepatoectomy,LH)也蓬勃發(fā)展起來。隨著腹腔鏡肝臟切除術(shù)的研究報(bào)道日益增加,國內(nèi)外已經(jīng)有大量關(guān)于腹腔鏡肝切除術(shù)的安全性和有效性的文獻(xiàn)研究。本文回顧性分析了我院行腹腔鏡和開腹肝切除手術(shù)治療的患者資料,旨在探討腹腔鏡肝切除在肝臟疾病的外科手術(shù)治療中的臨床價(jià)值。方法:回顧性分析2015年4月至2016年11月期間,符合排除納入標(biāo)準(zhǔn)的在青島大學(xué)附屬醫(yī)院肝膽胰外科住院行腹腔鏡肝切除術(shù)的83例患者(其中肝腫瘤患者61例,肝膽管結(jié)石患者22例),及同期行開腹肝切除術(shù)的82例患者(其中肝腫瘤患者45例,肝膽管結(jié)石患者37例),對施行腹腔鏡手術(shù)和開腹手術(shù)的肝腫瘤患者與肝膽管結(jié)石患者分別比較,分析比較腹腔鏡肝切除和開腹肝切除治療肝臟疾病的療效。根據(jù)其手術(shù)方式分為LH(Laparoscopic hepatectomy)組及OH(Open hepatectomy)組。分別比較肝腫瘤患者和肝膽管結(jié)石患者的手術(shù)時(shí)間、術(shù)中出血量,術(shù)中輸血患者比例、術(shù)中行肝門阻斷患者比例、術(shù)中住院天數(shù)、術(shù)后第1d、3d、5d、7d肝功能恢復(fù)情況以及術(shù)后并發(fā)癥的情況,對比腹腔鏡肝切除術(shù)與開腹肝切除術(shù)的短期臨床評價(jià)指標(biāo),評估腹腔鏡手術(shù)治療肝臟腫瘤、肝膽管結(jié)石的近期療效和安全性。所有數(shù)據(jù)應(yīng)用SPSS 19.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,P0.05表示差異有顯著性。結(jié)果:所有手術(shù)均順利完成,圍手術(shù)期無死亡病例,通過分析腹腔鏡肝切除術(shù)患者組(LH組)與開腹肝切除術(shù)患者組(OH組)的統(tǒng)計(jì)資料,發(fā)現(xiàn)無論是肝腫瘤患者還是肝膽管結(jié)石患者,術(shù)前在性別比例、年齡、病變位置、病變大小、Child A級患者所占百分比、術(shù)前肝功能指標(biāo)等方面沒有明顯差別(P0.05);而術(shù)后統(tǒng)計(jì)資料的比較中,LH組和OH組在手術(shù)時(shí)間、患者術(shù)中輸血比例、術(shù)中行肝門阻斷者比例方面無明顯差異(P0.05),在術(shù)中出血量、術(shù)后住院日、術(shù)后肝功能恢復(fù)速度等方面均優(yōu)于OH組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:同開腹手術(shù)相比,腹腔鏡肝切除術(shù)具有手術(shù)創(chuàng)傷輕,術(shù)后恢復(fù)快、住院時(shí)間縮短等諸多優(yōu)點(diǎn),對于治療肝臟良惡性疾病是安全可行的。
[Abstract]:Objective: with the development of science and technology, the continuous revolution and innovation of surgical instruments and surgical methods in the field of surgery make great progress in minimally invasive surgery.Minimally invasive techniques have penetrated into every field of surgery, and laparoscopic hepatectomy has flourished.With the increasing number of studies on laparoscopic hepatectomy, there have been a lot of literatures on the safety and effectiveness of laparoscopic hepatectomy at home and abroad.The clinical data of patients undergoing laparoscopic and open hepatectomy in our hospital were retrospectively analyzed in order to explore the clinical value of laparoscopic hepatectomy in the surgical treatment of liver diseases.Methods: from April 2015 to November 2016, 83 patients (61 patients with liver tumor) who were hospitalized in the Department of Hepatobiliary and Pancreatic surgery, Qingdao University affiliated Hospital, were analyzed retrospectively.There were 22 patients with hepatolithiasis and 82 patients with hepatectomy at the same time (including 45 patients with liver tumor).A total of 37 patients with hepatolithiasis underwent laparoscopic and open hepatectomy were compared with those with hepatolithiasis. The efficacy of laparoscopic hepatectomy and open hepatectomy in the treatment of liver diseases was analyzed and compared.According to its operation mode, it was divided into LH(Laparoscopic group and OH(Open group.The operative time, intraoperative blood loss, blood transfusion, hepatic hilus occlusion and hospitalization were compared between patients with hepatic tumor and patients with hepatolithiasis.The recovery of liver function and postoperative complications were observed on the 1st day, 3rd day and 5th day after operation. The short-term clinical evaluation indexes of laparoscopic hepatectomy and open hepatectomy were compared to evaluate the short-term efficacy and safety of laparoscopic hepatectomy in the treatment of liver tumors and hepatolithiasis.All the data were statistically analyzed by SPSS 19.0 software.Results: all the operations were completed successfully. There were no death cases in perioperative period. The statistical data of the patients with laparoscopic hepatectomy (LH group) and open hepatectomy group (OH group) were analyzed.It was found that the percentage of Child-A patients with liver tumor or hepatolithiasis before operation in sex ratio, age, location of lesion and size of lesion were found.There was no significant difference in preoperative liver function indexes between LH group and OH group in the time of operation, the proportion of blood transfusion during operation, and the proportion of patients undergoing hepatic hilar occlusion, but there was no significant difference in blood loss during operation between LH group and OH group.The days of hospitalization and the recovery rate of postoperative liver function were better than those of OH group (P 0.05).Conclusion: compared with open surgery, laparoscopic hepatectomy is safe and feasible for the treatment of benign and malignant liver diseases.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7;R657.3

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