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腹腔镜下右半肝切除术治疗右肝肿瘤的围手术期疗效评估_论文

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第 29 卷第 4 期 2017 年 7 月 肝 胆 胰 外 科 杂 志 Journal of Hepatopancreatobiliary Surgery Vol.29 No.4 Jul. 2017 ? 论著 临床研究 ? 腹腔镜下右半肝切除术治疗右肝肿瘤的 围手术期疗效评估 龚安安 1,张成武 2,周蒙滔 3 (1.温州医科大学附属义乌医院暨浙江省义乌市中心医院 肝胆胰外科, 浙江 金华 322000; 2.浙江省 人民医院 肝胆胰外科, 浙江 杭州 310000; 3.温州医科大学附属第一医院 肝胆外科, 浙江 温州 325000) [摘? 要]? 目的? 比较腹腔镜下右半肝切除术与开腹右半肝切除术治疗右肝肿瘤的围手术期疗效。方法 回顾性分析2015 年1 月至2016 年6 月浙江省人民医院收治的36 例右半肝肿瘤行右半肝切除患者资料。根 据手术方法分为腹腔镜右半肝切除组 (15 例) 和开腹右半肝切除组 (21 例) ,比较两组患者围手术期疗效。 t= 结果? 腹腔镜右半肝切除组与开腹右半肝切除组在切口长度[ (8.93±1.53) cm vs (22.62±2.56) cm, P <0.05]、手术时间[ (305.67±42.96) min vs(254.29±53.53) min, t =-3.073, P <0.05]及术中 19.992, t =3.242, P <0.05]方面, 组间差异均具有统计学意义。 出血量[ (386.67±201.31) mL vs(747.62±451.24) mL, 与开腹右半肝切除组相比, 腹腔镜右半肝切除组术后胃肠道通气时间[ (2.60±1.30) d vs(9.24± 4.22) d, t =2.107, P <0.05]、术后住院时间[ (10.93±2.28) d vs (14.71±5.17) d, t =2.971, P <0.05]及并发症 P <0.05) 均较低,组间差异有统计学意义。术中第一肝门阻断,腹? 发生率 (13.33% vs 47.62%,χ2=4.629, P >0.05) ;术后标本肿 腔镜右半肝切除组为2例, 开腹右半肝切除组为8例, 差异无统计学意义 (χ2=2.674, 瘤切缘,腹腔镜右半肝切除组为 (8.13±3.74) mm,开腹右半肝切除组为 (10.24±4.12) mm,组间差异学无 P >0.05) 。结论? 腹腔镜下右半肝切除治疗右肝肿瘤方法可行,较开腹右半肝切除 统计学意义 (t =1.569, 胃肠道功能恢复快, 住院时间短, 并发症少, 具有创伤小、安全性高等特点, 术后疗效肯定, 值得临床推广。 [关键词]? 腹腔镜;右半肝切除术;右肝肿瘤;围手术期疗效 [中图分类号] R735.7 [文献标识码] A doi:10.11952/j.issn.1007-1954.2017.04.002 The perioperative curative effect assessment of totally laparoscopic right hepatectomy in the treatment of right liver tumor? GONG An-an1, ZHANG Cheng-wu2, ZHOU Meng-tao3.? 1Department of Hepatobiliary Surgery, Yiwu Central Hospital, Jinhua, Zhejiang 322000, China; 2Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Hangzhou 310000, China; 3Department of Hepatobiliary Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China Abstract Objective To compare the perioperative curative effect of laparoscopic right hepatectomy and open right hepatectomy for right liver tumors. Methods The data of 36 patients with right liver tumor who underwent right hepatectomy in Zhejiang Provincial People’s Hospital from Jan. 2015 to Jun. 2016 were retrospectivly analyzed. According to operation methods, the patients were divided into laparoscopic right hepatectomy group (n=15) and open right hepatectomy group (n=21). The perioperative curative effect were compared. Results There was statistical difference in incision length [(8.93±1.53) cm vs (22.62±2.56) cm, t=19.992, P<0.05], operation duration [(305.67±42.96) min vs (254.29±53.53) min, t=-3.073, P<0.05] and intraoperative



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