Comparison of safety and short-term efficacy between laparoscopic hepatectomy and open hepatectomy

doi:10.3877/cma.j.issn.2095-3232.2020.06.011

Abstract

Abstract:

Objective

To compare the safety and short-term efficacy of laparoscopic and open hepatectomy.

Methods

Clinical data of 125 patients who underwent hepatectomy in the Affiliated Hospital of Inner Mongolia Medical University from January 2015 to December 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different surgical procedure, all patients were divided into the laparoscopic hepatectomy (n=60) and open hepatectomy groups (n=65). In the laparoscopic hepatectomy group, 35 patients were male and 25 female, aged 16-75 years, with a median age of 55 years. In the open hepatectomy group, 37 patients were male and 28 female, aged 15-76 years, with a median age of 54 years. The operation time, age were compared between two groups by t test. The incidence of postoperative complications was compared by Chi-square test.

Results

All patients in two groups successfully completed the operation. In the laparoscopic hepatectomy group, 5 cases were converted to open hepatectomy with a conversion rate of 8%(5/60). No death case was reported. The average operation time in the laparoscopic hepatectomy group was (145±53) min, significantly longer than (128±30) min in the open hepatectomy group (t=2.267, P<0.05). In the laparoscopic hepatectomy group, the postoperative exhaust time, first off-bed activity time, analgesic use time, abdominal drainage time and postoperative length of hospital stay were (2.5±0.7), (1.7±0.6), (2.1±0.7), (5.1±2.2) and (6.4±2.6) d, significantly shorter than (3.0±0.7), (3.0±0.7), (2.8±1.5), (7.0±1.7) and (8.8±2.1) d in the open hepatectomy group (t=-4.195, -11.164, -4.024, -5.456, -5.701; P<0.05). In the laparoscopic hepatectomy group, 2 cases developed postoperative bleeding,3 cases of bile leakage and 2 cases of infection, and it was 4, 8 and 6 cases accordingly in the open hepatectomy group. The incidence of postoperative complications in laparoscopic hepatectomy group was significantly lower than that in the open hepatectomy group (χ2=5.008, P<0.05).

Conclusions

Compared with open hepatectomy, laparoscopic hepatectomy has advantages in terms of higher safety, better short-term efficacy, fewer postoperative complications, less invasiveness and faster postoperative recovery.

Key words: Laparoscopes, Hepatectomy, Liver neoplasms

Yibo Liu, Xingkai Meng, Jianjun Ren, Jun Li, Jianliang Qiao, Junjing Zhang. Comparison of safety and short-term efficacy between laparoscopic hepatectomy and open hepatectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(06): 547-551.

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References 20

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组别	例数	年龄（岁，±s)	性别（例）		原发病（例）					Child-Pugh分级（例）		ALT[U/L，M(R)]
组别	例数	年龄（岁，±s)	男	女	包虫病	肝血管瘤	肝癌、囊腺癌	肝腺瘤	其他	A级	B级	ALT[U/L，M(R)]
腹腔镜组	60	54±15	35	25	8	42	6	2	2	56	4	27(95)
开腹组	65	53±14	37	28	10	36	8	3	3	58	7	28(115)
统计值		t=0.336	χ²=0.654		χ²=0.025					χ²=0.654		Z=-0.487
P值		0.737	0.419		0.873					0.419		0.626

组别	例数	年龄（岁，±s)	性别（例）		原发病（例）					Child-Pugh分级（例）		ALT[U/L，M(R)]
组别	例数	年龄（岁，±s)	男	女	包虫病	肝血管瘤	肝癌、囊腺癌	肝腺瘤	其他	A级	B级	ALT[U/L，M(R)]
腹腔镜组	60	54±15	35	25	8	42	6	2	2	56	4	27(95)
开腹组	65	53±14	37	28	10	36	8	3	3	58	7	28(115)
统计值		t=0.336	χ²=0.654		χ²=0.025					χ²=0.654		Z=-0.487
P值		0.737	0.419		0.873					0.419		0.626

组别	例数	手术时间（min，±s）	术中出血量[ml，M(R)]	肝切除术式（例）			输血（例）
组别	例数	手术时间（min，±s）	术中出血量[ml，M(R)]	局部切除	肝叶切除	半肝切除	输血（例）
腹腔镜组	60	146±53	300（1 000）	18	39	3	3
开腹组	65	128±30	300（1 100）	11	42	12	3
统计值		t=2.267	Z=-1.438	χ²=7.012			χ²=0.001
P值		0.026	0.151	0.030			1.000

组别	例数	手术时间（min，±s）	术中出血量[ml，M(R)]	肝切除术式（例）			输血（例）
组别	例数	手术时间（min，±s）	术中出血量[ml，M(R)]	局部切除	肝叶切除	半肝切除	输血（例）
腹腔镜组	60	146±53	300（1 000）	18	39	3	3
开腹组	65	128±30	300（1 100）	11	42	12	3
统计值		t=2.267	Z=-1.438	χ²=7.012			χ²=0.001
P值		0.026	0.151	0.030			1.000

组别	例数	ALT[U/L，M(R)]	术后排气时间（d, ±s）	首次下床活动时间（d, ±s）	镇痛药使用时间（d, ±s）	腹腔引流时间（d, ±s）	术后住院时间（d, ±s）
腹腔镜组	60	306（1 049）	2.5±0.7	1.7±0.6	2.1±0.7	5.1±2.2	6.4±2.6
开腹组	65	390（1 213）	3.0±0.7	3.0±0.7	2.8±1.5	7.0±1.7	8.8±2.1
统计值		Z=-1.715	t=-4.195	t=-11.164	t=-4.024	t=-5.456	t=-5.701
P值		0.860	<0.001	<0.001	<0.001	<0.001	<0.001

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