摘要目的 探讨腹腔镜肝切除术治疗肝脏恶性肿瘤的可行性与安全性.方法 136例肝癌患者分为两组,腹腔镜手术组(LR组)51例,开腹手术组(OR组)85例.分析两组患者术后血清酶学、炎性因子以及术后并发症情况.结果 LR组手术时间明显长于OR组(252±123) min比(169±63) min;住院时间(10±5)d比(12±5)d和术中出血量LR组均少于OR组(381±156)ml比(523±325)m1(均P＜0.05).术后LR组ALT、AST、ALP均显著低于OR组[ALT:(227±101) U/L比(690±575) U/L),AST:(187±107) U/L比(551±529) U/L,ALP:(63±25) U/L比(86±40) U/L,均P ＜0.05).凝血酶原时间(PT)LR组较OR组缩短[(14.3±0.8)s比(15.3±1.6)s,P=0.000)].术后患者IL-6、TNF-α水平LR组较OR组低[IL-6:(154±31) pg/ml比(182±34) pg/ml,TNF-α:(22±6)pg/ml比(30±7)pg/ml,均P＜0.05].腹腔镜组术后并发症明显低于开腹组(3.9％比11.8％,P＜0.05).结论 腹腔镜切除肝脏恶性肿瘤并发症少,炎性应激反应与肝脏损伤更轻.

abstractsObjective To explore the feasibility and safety of laparoscopic hepatectomy in the treatment of hepatic malignant tumors.Methods 136 liver cancer patients were divided into:laparoscopic surgery group (LR group,51 cases) and open surgery group (OR group,85 cases).Serum enzyme,inflammatory factors and postoperative complications were compared between the 2 groups.Results The operative time of LR group was significantly longer than that of OR group (252 ± 123) min vs.(169 ± 63 min),hospitalization time (10 ± 5) d vs.(12 ± 5) d and intraoperative blood loss in LR group were lower than those in OR group (381 ±156) ml vs.(523 ±325) ml (all P＜0.05).ALT,AST,ALP in LR group was significantly lower than that in OR group [ALT:(227 ±101) U/L vs.(690 ±575) U/L,AST:(187±107) U/Lvs.(551 ±529) U/L,ALP:(63 ±25)U/Lvs.(86 ±40)U/L,allP＜0.05].Prothrombin time in LR group was shorter than that in OR group [(14.3 ±0.8) s vs.(15.3 ± 1.6)s,P =0.000].The postoperative IL-6,TNF-α in LR group was lower than that in OR group [IL-6:(154 ±31)pg/ml vs.(182 ±34) pg/ml,TNF-α:(22 ±6) pg/ml vs.(30 ±7) pg/ml,all P ＜0.05].Postoperative complications in laparoscopic group were significantly lower than those in laparotomy group (3.9％ vs.11.8％,P ＜ 0.05).Conclusions Laparoscopic resection of liver malignant tumors is safer and has less complications,lower inflammatory stress response and liver injury.