开腹肝切除术与腹腔镜肝切除术治疗肝脏疾病的短期疗效及费用对比分析
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摘要
目的本文对开腹肝切除术(OH)及腹腔镜肝切除术(LH)的短期疗效及住院费用进行对比分析,从而为手术医师在术式选择上提供参考。方法本文收集北京大学深圳医院2012年1月1日至2018年10月30日,共98例接受LH及OH的病人资料,其中LH组38例;OH组60例,对比两组数据在手术时间、术中出血、是否行肝门阻断、术后下床时间、术后恢复进食时间、术后使用止痛药时间、术后出院时间、是否出现并发症、术后第1天肝功能变化及费用的差异,来评估OH与LH在术后短期疗效及费用上的差异。结果相较于OH组,LH组在手术时间、术中出血、肝门阻断率、下床时间、恢复进食时间、术后出院时间等方面相对较少,有统计学意义(P<0.05);而在术后第1天肝功能变化、术后使用止痛药时间、是否出现并发症等方面无统计学意义(P<0.05);LH组费用均值低于OH组,但无统计学意义(P>0.05)。结论在严格执行适应症的条件下,LH在术后短期疗效方面较OH有优势,且未增加费用负担。临床手术医师需综合考虑,选择合适的术式。
Objective This study compares the short-term efficacy and hospitalization costs between open hepatectomy(OH)and laparoscopic hepatectomy(LH),so as to provide a reference for surgeons in the choice of surgical methods.Methods The data of 98 patients received LH and OH in Shenzhen Hospital of Peking University from January 01,2012 to October 30,2018 were collected,including 38 cases in LH group and 60 cases in OH group.The data of the two groups were compared in operation time,intraoperative bleeding,hepatic hilar occlusion,postoperative time to get out of bed,postoperative time to resume eating,postoperative time to use painkillers,postoperative discharge time,whether complications occurred.The changes of liver function and the difference of cost,To evaluate the difference in short-term efficacy and cost between OH and LH.Results Compared with OH group,LH group had less operation time,intraoperative bleeding,hilar obstruction rate,getting out of bed time,resuming eating time,postoperative discharge time.There was no significant difference in the changes of liver function and the time of analgesic use(P>0.05).The average cost of LH group was lower than OH group on the first day after operation(P<0.05),however,there was no statistical significance(P>0.05).Conclusion Under the condition of strict implementation of indications,LH has advantages over OH in short-term effect after operation,and does not increase the cost.Surgeons need to consider comprehensively and choose the appropriate operative method.
Objective This study compares the short-term efficacy and hospitalization costs between open hepatectomy(OH)and laparoscopic hepatectomy(LH),so as to provide a reference for surgeons in the choice of surgical methods.Methods The data of 98 patients received LH and OH in Shenzhen Hospital of Peking University from January 01,2012 to October 30,2018 were collected,including 38 cases in LH group and 60 cases in OH group.The data of the two groups were compared in operation time,intraoperative bleeding,hepatic hilar occlusion,postoperative time to get out of bed,postoperative time to resume eating,postoperative time to use painkillers,postoperative discharge time,whether complications occurred.The changes of liver function and the difference of cost,To evaluate the difference in short-term efficacy and cost between OH and LH.Results Compared with OH group,LH group had less operation time,intraoperative bleeding,hilar obstruction rate,getting out of bed time,resuming eating time,postoperative discharge time.There was no significant difference in the changes of liver function and the time of analgesic use(P>0.05).The average cost of LH group was lower than OH group on the first day after operation(P<0.05),however,there was no statistical significance(P>0.05).Conclusion Under the condition of strict implementation of indications,LH has advantages over OH in short-term effect after operation,and does not increase the cost.Surgeons need to consider comprehensively and choose the appropriate operative method.
引文
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[22]Kehlet H.Principles of fast track surgery:Multimodal perioperative therapy programme[J].Der Chirurg,2009,80(8):687-689.
[23]骆鹏飞,荚卫东,许戈良,等.肝切除术后疼痛分析[J].中华普通外科杂志,2015,30(3):194-197.
[24]荚卫东.精准肝切除治疗肝细胞癌关键技术[J].中国普通外科杂志,2014,23(1):1-5.2019-03-16
[2]叶义标,梁敏,陈捷,等.腹腔镜联合开腹同期切除结直肠癌伴肝转移的可行性分析[J].岭南现代临床外科,2013,13(5):375-378.
[3]Marvin MR,Buell JF.Laparoscopic liver surgery[J].Adv Surgery,2009,43(1):159-173.
[4]周伟平,孙志宏,吴孟超,等.经腹腔镜肝叶切除首例报道[J].肝胆外科杂志,1994(2):82.
[5]Goergen M,Azagra JS,Sanz CM.Simultaneous laparoscopic and transanal approach to rectal tumors[J].Dis Colon Rectum,1996,39(3):358-360.
[6]郑树国,李建伟,陈健,等.腹腔镜肝切除术临床应用的经验体会[J].中华肝胆外科杂志,2011,17(8):614-617.
[7]荚卫东.肝切除术后加速康复质量控制与持续改进[J].中国普通外科杂志,2018,27(1):1-5
[8]Zhu P,Liao W,Ding ZY,et al.Intraoperative ultrasonography of robot-assisted laparoscopic hepatectomy:initial experiences from 110 consecutive cases[J].Surg Endosc,2018,32(10):4071-4077.
[9]经翔,丁建民,王彦冬,等.术中超声在肝癌切除术中的应用研究[J].中华医学超声杂志(电子版),2010,7(10):1674-1679.
[10]Hüscher CG,Lirici MM,Chiodini S.Laparoscopic liver resections[J].Semin Laparosc Surg,1998,5(3):204-210.
[11]崔富强,庄辉.我国乙型肝炎防控工作进展、挑战及对策[J].中国病毒病杂志,2016,6(2):81-87.
[12]Weinbaum CM,Williams I.Recommendations for identification and public health management of persons with chronic hepatitis B virus infection[J].Hepatology,2010,49(S5):S35-S44.
[13]鲁嘉越,王坚.原发性肝内胆管结石成因研究现状[J].中华肝胆外科杂志,2011,17(2):168-170.
[14]Ding G,Cai W,Qin M et al.Pure laparoscopic versus open liver resection in treatment of hepatolithiasis within the left lobes:a randomized trial study[J].Surg Laparosc Endosc Percutan Tech,2015,25(5):392-394.
[15]Fan ST,Ng IO,Poon RT,et al.Hepatectomy for hepatocellular carcinoma:the surgeon's role in long-term survival[J].Arch Surg,1999,134(10):1124-1130.
[16]Morise Z,Kawabe N,Tomishige H,et al.Recent advances in the surgical treatment of heaptocellular carcinoma[J].World JGastroenterol,2014,20(39):14381-14392.
[17]Constant DL,Slakey DP,Campeau RJ,et al.Laparoscopic nonanatomic hepatic resection employing the LigaSure device[J].JSLS,2005,9(1):35-38.
[18]陈亚进,陈捷.能量外科器械在肝脏手术中的应用[J].中华肝脏外科手术学电子杂志,2015,4(1):9-12.
[19]Morino M,Morra I,Rosso E,et al.Laparoscopic vs open hepatic resection:a comparative study[J].Surg Endosc,2003,17(12):1914-1918.
[20]Wilmore DW,Kehlet H.Management of patients in fast track surgery[J].BMJ,2001,322(7284):473-476.
[21]Wilmore DW.Therapy which enhances surgical recovery:the potential for multimodality,fast-track surgery in the 21st century[J].Nihon Geka Gakkai Zasshi,2000,101(3):281-283.
[22]Kehlet H.Principles of fast track surgery:Multimodal perioperative therapy programme[J].Der Chirurg,2009,80(8):687-689.
[23]骆鹏飞,荚卫东,许戈良,等.肝切除术后疼痛分析[J].中华普通外科杂志,2015,30(3):194-197.
[24]荚卫东.精准肝切除治疗肝细胞癌关键技术[J].中国普通外科杂志,2014,23(1):1-5.2019-03-16