Morino M, Morra I, Rosso E, Miglietta C, Garrone C
Second Department of General Surgery, University of Turin, C.so A.M. Dogliotti 14, 10126 Turin, Italy.
Surg Endosc. 2003 Dec;17(12):1914-8. doi: 10.1007/s00464-003-9070-4. Epub 2003 Oct 28.
Although the feasibility of minor laparoscopic liver resections (LLR) has been demonstrated, data comparing the open vs the laparoscopic approach to liver resection are lacking.
We compared 30 LLR with 30 open liver resections (OLR) in a pair-matched analysis. The indications for resection were malignant disease in 47% of the LLR and 83% of the OLR. The average size of the lesions was 42 mm for LLR and 41 mm for OLR. Five wedge resections, 12 segmentectomies, and 13 bisegmentectomies were performed in each group.
The conversion rate for LLR was nil. The mean operative time was 148 min for LLR and 142 min for OLR. Mean blood loss was minimal in the LLR group (320 vs 479 ml; p < 0.05). Postoperative complications occurred in 6.6% of the patients in each group; there were no deaths. The mean postoperative hospital stay was shorter for LLR patients (6.4 vs 8.7 days; p < 0.05). In tumors, the resection margin was <1 cm in 43% of the LLR patients and 40% of the OLR patients ( p = NS).
Minor LLR of the anterior segments has the same rates of mortality and morbidity as OLR. However, the laparoscopic approach reduces blood loss and postoperative hospital stay.
尽管小型腹腔镜肝切除术（LLR）的可行性已得到证实，但缺乏比较肝切除术开放与腹腔镜两种术式的数据。
我们采用配对分析比较了30例LLR和30例开放性肝切除术（OLR）。LLR组47%和OLR组83%的切除指征为恶性疾病。LLR组病变平均大小为42mm，OLR组为41mm。每组均进行了5例楔形切除术、12例肝段切除术和13例双肝段切除术。
LLR组的中转率为零。LLR组平均手术时间为148分钟，OLR组为142分钟。LLR组平均失血量极少（320 vs 479 ml；p<0.05）。每组6.6%的患者发生术后并发症；无死亡病例。LLR患者术后平均住院时间较短（分别为6.4天和8.7天；p<0.05）。在肿瘤方面，43%的LLR患者和40%的OLR患者切缘<1cm（p=无显著差异）。
前段小型LLR的死亡率和发病率与OLR相同。然而，腹腔镜手术方式减少了失血量和术后住院时间。
