Wang Xi-Tao, Wang Hong-Guang, Duan Wei-Dong, Wu Cong-Ying, Chen Ming-Yi, Li Hao, Huang Xin, Zhang Fu-Bo, Dong Jia-Hong
From the Department of Hepatobiliary Surgery (X-TW, H-GW, W-DD, M-YC, HL, XH, F-B, J-HD), Chinese PLA General Hospital, Beijing; School of Medicine (X-TW, XH, F-B, J-HD), Nankai University, Tianjin; and Institute of Systems Biomedicine (C-YW), Peking University, Beijing, China.
Medicine (Baltimore). 2015 Oct;94(43):e1854. doi: 10.1097/MD.0000000000001854.
Pure laparoscopic liver resection (PLLR) has been reported to be as safe and effective as open liver resection (OLR) for liver lesions, and it is associated with less intraoperative blood loss, shorter hospital stay, and lower complication rate. However, studies comparing PLLR with OLR in elderly patients were limited. The aim of this study was to analyze the short-term outcome of PLLR versus OLR for primary liver carcinoma (PLC) in elderly patients.Between January 2008 and October 2014, 30 consecutive elderly patients (≥70 years) who underwent PLLR for PLC were included into analysis. Sixty patients who received OLR for PLC during the same study period were also included as a case-matched control group. Patients were well matched in terms of age, sex, comorbid illness, Child Pugh class, American Society of Anesthesiologists grade, tumor size, tumor location, and extent of hepatectomy.No significant differences were observed with regard to patient preoperative baseline status, median tumor size (Group PLLR 4.0 cm vs Group OLR 5.0 cm, P = 0.125), tumor location, extent of hepatectomy, and operation time (Group PLLR 133 minutes vs Group OLR 170 minutes, P = 0.073). Compared with OLR, the PLLR group displayed a significantly less frequent Pringle maneuver application (10.0% vs 70.0%, P < 0.001), less blood loss (100 vs 300 mL; P < 0.001), shorter hospital stay (5 vs 10 days; P < 0.001), and lower total hospitalization cost ($9147.50 vs $10,867.10, P = 0.008). The postoperative complication rates were similar between groups (Group PLLR 10.0% vs Group OLR 16.7%; P = 0.532). There was no hospital mortality in both groups.PLLR for PLC is as safe and feasible as OLR, but with less blood loss, shorter hospital stay, and lower hospitalization cost for selected elderly patients.
据报道，对于肝脏病变，单纯腹腔镜肝切除术（PLLR）与开腹肝切除术（OLR）一样安全有效，且术中出血量更少、住院时间更短、并发症发生率更低。然而，比较PLLR与OLR在老年患者中的研究有限。本研究的目的是分析老年患者原发性肝癌（PLC）行PLLR与OLR的短期结局。
2008年1月至2014年10月，30例连续接受PLLR治疗PLC的老年患者（≥70岁）纳入分析。同期60例接受OLR治疗PLC的患者也作为病例匹配对照组纳入。患者在年龄、性别、合并疾病、Child Pugh分级、美国麻醉医师协会分级、肿瘤大小、肿瘤位置和肝切除范围方面匹配良好。
患者术前基线状态、中位肿瘤大小（PLLR组4.0 cm vs OLR组5.0 cm，P = 0.125）、肿瘤位置、肝切除范围和手术时间（PLLR组133分钟vs OLR组170分钟，P = 0.073）方面未观察到显著差异。与OLR相比，PLLR组Pringle手法应用频率显著更低（10.0% vs 70.0%，P < 0.001）、出血量更少（100 vs 300 mL；P < 0.001）、住院时间更短（5 vs 10天；P < 0.001）、总住院费用更低（9147.50美元vs 10867.10美元，P = 0.008）。两组术后并发症发生率相似（PLLR组10.0% vs OLR组16.7%；P = 0.532）。两组均无医院死亡病例。
对于PLC，PLLR与OLR一样安全可行，但对于选定的老年患者，出血量更少、住院时间更短、住院费用更低。
