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[开放性与腹腔镜下小范围肝切除术治疗恶性肿瘤的比较——基于前50例病例的经验]

[Comparison of open and laparoscopic minor liver resections for malignant tumours - based on the experience of the first 50 cases].

作者信息

Sztipits Tamás, Mészáros Péter, Dubóczki Zsolt, Oláh Gergely, Mózer Andreas, Strausz Tamás, Mersich Tamás

机构信息

Daganatsebészeti Központ, Hasi Sebészeti Osztály, Országos Onkológiai Intézet Budapest, Ráth Gy. u. 7-9., 1122.

Sebészi és Molekuláris Daganatpatológiai Centrum, Országos Onkológiai Intézet Budapest.

出版信息

Orv Hetil. 2019 Jan;160(3):104-111. doi: 10.1556/650.2019.31254.

Abstract

INTRODUCTION

Laparoscopic resection of liver malignancies is gaining acceptance. Besides the advantages of minimally-invasive techniques, publications so far show no oncologic compromise of laparoscopy.

AIM

Our aim was to compare the results of our first fifty laparoscopic minor liver resections with traditional open procedures.

METHOD

We investigated laparoscopic and open minor liver resections performed in our institute between 01. 01. 2013 and 31. 03. 2017. Data were analysed retrospectively. Resection of maximum two segments was considered a minor resection. We compared the number of resected segments, intraoperative blood loss, operative time, 30 day morbidity and mortality, hospital stay, R1 resection ratio and resection margin width.

RESULTS

During the given period, 123 open and 55 laparoscopic minor liver resections of malignant liver tumours were performed. Open and laparoscopic groups were similar considering age, sex and health status. The ratio of bi-segmentectomies was significantly higher in the open group (p<0.001). Operation time (p = 0.91) and peri-operative transfusion ratio did not differ in the two groups (p = 0.102). 30 day morbidity and mortality were consistent (p = 0.50; p = 0.34), but patients in the laparoscopic group spent shorter time in hospital (p = 0.0001). The average width of resection margins and the ratio of R1 resections showed no difference between open and laparoscopic groups (p = 0.447; p = 0.263).

CONCLUSION

Our investigation indicates that in malignant liver tumours, laparoscopic resection significantly shortens hospital stay without oncologic compromise, even though 30 day morbidity and mortality does not show difference. We conclude that laparoscopic minor resection of malignant liver tumours is safe and feasible. Orv Hetil. 2019; 160(3): 104-111.

摘要

引言

腹腔镜肝恶性肿瘤切除术越来越被认可。除了微创技术的优势外,目前的文献表明腹腔镜手术在肿瘤学方面并无劣势。

目的

我们的目的是比较我们最初的50例腹腔镜小肝切除术与传统开放手术的结果。

方法

我们调查了2013年1月1日至2017年3月31日在我院进行的腹腔镜和开放小肝切除术。对数据进行回顾性分析。最多切除两个肝段被视为小肝切除术。我们比较了切除的肝段数量、术中出血量、手术时间、30天发病率和死亡率、住院时间、R1切除率和切缘宽度。

结果

在给定期间,共进行了123例开放性和55例腹腔镜小肝恶性肿瘤切除术。开放组和腹腔镜组在年龄、性别和健康状况方面相似。开放组双肝段切除术的比例显著更高(p<0.001)。两组的手术时间(p = 0.91)和围手术期输血率无差异(p = 0.102)。30天发病率和死亡率一致(p = 0.50;p = 0.34),但腹腔镜组患者的住院时间较短(p = 0.0001)。开放组和腹腔镜组的平均切缘宽度和R1切除率无差异(p = 0.447;p = 0.263)。

结论

我们的研究表明,对于肝恶性肿瘤,腹腔镜切除术可显著缩短住院时间,且在肿瘤学方面并无劣势,尽管30天发病率和死亡率无差异。我们得出结论,腹腔镜小肝恶性肿瘤切除术是安全可行的。《匈牙利医学周报》2019年;160(3): 104 - 111。

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