Slakey Douglas P, Simms Eric, Drew Barbara, Yazdi Farshid, Roberts Brett
Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112-2699, USA.
JSLS. 2013 Jan-Mar;17(1):46-55. doi: 10.4293/108680812X13517013317716.
Minimally invasive surgery for liver resection remains controversial. This study was designed to compare open versus laparoscopic surgical approaches to liver resection.
We performed a single-center retrospective chart review.
We compared 45 laparoscopic liver resections with 17 open cases having equivalent resections based on anatomy and diagnosis. The overall complication rate was 25.8%. More open resection patients had complications (52.9% vs 15.5%, P < .008). The conversion rate was 11.1%. The mean blood loss was 667.1 ± 1450 mL in open cases versus 47.8 ± 89 mL in laparoscopic cases (P < .0001). Measures of intravenous narcotic use, intensive care unit length of stay, and hospital length of stay all favored the laparoscopic group. Patients were more likely to have complications or morbidity in the open resection group than in the laparoscopic group for both the anterolateral (P < .085) and posterosuperior (P < .002) resection subgroups.
In this series comparing laparoscopic and open liver resections, there were fewer complications, more rapid recovery, and lower morbidity in the laparoscopic group, even for those resections involving the posterosuperior segments of the liver.
肝切除的微创手术仍存在争议。本研究旨在比较肝切除的开放手术与腹腔镜手术方式。
我们进行了一项单中心回顾性病历审查。
我们将45例腹腔镜肝切除术与17例基于解剖结构和诊断进行了等效切除的开放手术病例进行了比较。总体并发症发生率为25.8%。更多接受开放切除术的患者出现并发症（52.9%对15.5%，P <.008）。中转率为11.1%。开放手术病例的平均失血量为667.1±1450毫升，而腹腔镜手术病例为47.8±89毫升（P <.0001）。静脉使用麻醉剂的剂量、重症监护病房住院时间和住院总时间等指标均显示腹腔镜组更具优势。在前外侧（P <.085）和后上侧（P <.002）切除亚组中，开放切除组患者比腹腔镜组更易出现并发症或发病。
在本系列比较腹腔镜和开放肝切除术的研究中，腹腔镜组并发症更少、恢复更快且发病率更低，即使是那些涉及肝脏后上侧段的切除术。
