Clinical application value of laparoscopic hepatectomy in treatment of liver neoplasms

doi:10.3877/cma.j.issn.2095-3232.2016.01.006

Abstract

Abstract:

Objective

To investigate the application value of laparoscopic hepatectomy (LH) in the treatment of liver neoplasms.

Methods

Clinical data of 78 patients with liver neoplasms undergoing hepatectomy in Zhongnan Hospital of Wuhan University from June 2011 to June 2014 were retrospectively analyzed. The patients were divided into the LH group (n=31) and open hepatectomy (OH) group (n=47). The informed consents of all patients were obtained and the local ethical committee approval had been received. Intra- and post-operative situation and liver function of two groups were compared. Normally distributed data of two groups were compared with t test, non-normally distributed data were compared with rank-sum test and the comparison of rate was conducted using Chi-square test.

Results

Intraoperative blood loss, length of wound, retention time of abdominal drainage catheter, postoperative start time of eating and average postoperative length of hospital stay in the LH group were 150(100-200) ml, 5(4-6) cm, 5(3-6) d, 2(2-2) d and (8±3) d, which were significantly less compared with 300(300-600) ml, 20 (18-20) cm, 8(6-10) d, 3(2-3) d and (12±4) d in the OH group (Z= -5.405, -7.760, -4.366, -3.746; t=-3.608; P<0.05). The hospitalization cost in the LH group was (51±7) thousand yuan, which was significantly higher than (45±10) thousand yuan in the OH group (t=3.198, P<0.05). On the postoperative 1, 3 day, the levels of aspartate aminotransferase (AST) and aspartate aminotransferase (ALT) in the LH group were 94(62-114), 47(42-58) and 116(68 -136), 46(39-50) U/L, which were significantly lower than 110(93-158), 152(95-220) and 141(97-236), 49(42-120) U/L in the OH group (Z=-2.416, -6.539, -2.764, -2.229; P<0.05). In the LH group, the serum levels of albumin (ALB) on the postoperative 1, 3 day were (31±6), (35±3) g/L, which were significantly higher compared with (25±5), (34±3) g/L (t=4.958, 2.191; P<0.05).

Conclusions

LH is an efficacious and safe treatment for liver neoplasms. Compared with OH, LH has obvious advantages of smaller incision and shorter recovery time.

Key words: Laparoscopes, Hepatectomy, Liver neoplasms

Haitao Wang, Weijie Ma, Mancheng Yu, Quanyan Liu, Yueming He, Dingyu Pan, Zhisu Liu, Yufeng Yuan. Clinical application value of laparoscopic hepatectomy in treatment of liver neoplasms[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(01): 21-25.

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References 19

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组别	例数	手术时间[min，M（Q_R）]	术中出血量[ml，M（Q_R）]	切口长度[cm，M（Q_R）]	术中阻断肝门（例）
腹腔镜组	31	180（150~240）	150（100~200）	5（4~6）	2
开腹组	47	180（160~210）	300（300~600）	20（18~20）	7
统计值	?	Z=-0.016	Z=-5.405	Z=-7.760	χ²=0.608
P值	?	0.988	0.000	0.000	0.435

组别	例数	手术时间[min，M（Q_R）]	术中出血量[ml，M（Q_R）]	切口长度[cm，M（Q_R）]	术中阻断肝门（例）
腹腔镜组	31	180（150~240）	150（100~200）	5（4~6）	2
开腹组	47	180（160~210）	300（300~600）	20（18~20）	7
统计值	?	Z=-0.016	Z=-5.405	Z=-7.760	χ²=0.608
P值	?	0.988	0.000	0.000	0.435

组别	例数	腹腔引流管留置时间[d，M（Q_R）]	术后开始进食时间[d，M（Q_R）]	术后住院时间[d，M（Q_R）]	住院总费用（万元，）	术后并发症分级（例）			病理类型（例）
组别	例数	腹腔引流管留置时间[d，M（Q_R）]	术后开始进食时间[d，M（Q_R）]	术后住院时间[d，M（Q_R）]	住院总费用（万元，）	Ⅰ级	Ⅱ级	Ⅲ级	良性	恶性
腹腔镜组	31	5（3~6）	2（2~2）	8±3	5.1±0.7	2	2	0	14	17
开腹组	47	8（6~10）	3（2~3）	12±4	4.4±1.0	2	6	6	15	32
统计值	?	Z=-4.366	Z=-3.746	t=-3.608	t=3.198	χ²=3.000			χ²=1.403
P值	?	0.000	0.000	0.001	0.002	0.083			0.236

组别	例数	腹腔引流管留置时间[d，M（Q_R）]	术后开始进食时间[d，M（Q_R）]	术后住院时间[d，M（Q_R）]	住院总费用（万元，）	术后并发症分级（例）			病理类型（例）
组别	例数	腹腔引流管留置时间[d，M（Q_R）]	术后开始进食时间[d，M（Q_R）]	术后住院时间[d，M（Q_R）]	住院总费用（万元，）	Ⅰ级	Ⅱ级	Ⅲ级	良性	恶性
腹腔镜组	31	5（3~6）	2（2~2）	8±3	5.1±0.7	2	2	0	14	17
开腹组	47	8（6~10）	3（2~3）	12±4	4.4±1.0	2	6	6	15	32
统计值	?	Z=-4.366	Z=-3.746	t=-3.608	t=3.198	χ²=3.000			χ²=1.403
P值	?	0.000	0.000	0.001	0.002	0.083			0.236

组别	例数	ALT [U/L，M（Q_R）]			AST [U/L，M（Q_R）]
组别	例数	术前	术后1 d	术后3 d	术前	术后1 d	术后3 d
腹腔镜组	31	32（21~40）	94（62~114）	47（42~58）	30（25~40）	116（68~136）	46（39~50）
开腹组	47	30（24~45）	110（93~158）	152（95~220）	31（26~40）	141（97~236）	49（42~120）
统计值	?	Z=-0.343	Z=-2.416	Z=-6.539	Z=-0.374	Z=-2.764	Z=-2.229
P值	?	0.732	0.016	0.000	0.709	0.006	0.026
组别	例数	TB [μmol/L，M（Q_R）]			ALB（g/L,）
组别	例数	术前	术后1 d	术后3 d	术前	术后1 d	术后3 d
腹腔镜组	31	15（12~21）	21（13~30）	22（15~29）	41±4	31±6	35±3
开腹组	47	15（13~21）	22（15~34）	21（16~30）	41±4	25±5	34±3
统计值	?	Z=-0.802	Z=-0.378	Z=-0.061	t=0.328	t=4.958	t=2.191
P值	?	0.442	0.705	0.951	0.744	0.000	0.031

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