Comparison of laparoscopic versus open liver tumor resection: a case-controlled study
Comparison of laparoscopic versus open liver tumor resection: a case-controlled study
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DOI：
10.1007/s00464-008-0262-9
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发表时间：
2009-04-01
影响因子：
3.1
通讯作者：
Berber, Eren
中科院分区：
文献类型：
--
作者：
Tsinberg, Michael;Tellioglu, Gurkan;Berber, Eren
尽管文献中有关于腹腔镜肝切除术安全性和有效性的数据，但在病例匹配设计中比较腹腔镜与开放手术的研究并不多。本研究的目的是比较腹腔镜与开放性肝切除术的围手术期结果从一个单一的institution.31例患者进行腹腔镜肝切除术1997年4月至2007年8月，与前瞻性腹腔镜程序开始于2006年4月（n = 25）。将该组患者与43例接受开放性切除术的连续患者进行比较，这些患者在病变大小（恶性病变≤ 5 cm，良性病变≤ 8 cm）、解剖位置（第2、3、4 b、5、6节段）和切除类型（楔形切除术、肝段切除术、部分肝切除术）方面匹配。数据来自医疗记录以及前瞻性数据库。采用t检验和卡方检验进行统计学分析。所有数据均表示为平均值+/-平均值的标准误差（SEM）。腹腔镜组的平均年龄为57.6 +/- A 2.7岁，而开放组为61.9 +/- A 2.3岁（p = 0.2）。腹腔镜组[74%女性（n = 23）和26%男性（n = 8）]中的女性多于开放组[40%女性（n = 17）和60%男性（n = 26）]（p = 0.003）。开放手术组（73%）的恶性病变患者多于腹腔镜手术组（45%）（p = 0.01）。腹腔镜组中8例患者接受部分肝切除术，23例患者接受节段性/楔形肝切除术，而开放组中15例患者接受部分肝切除术，28例患者接受节段性/楔形肝切除术（p = 0.7）。腹腔镜组的平均肿瘤大小为3.9 +/- A 0.4 cm，而开放组为4.2 +/- A 0.3 cm（p = 0.5）。腹腔镜组31例中有10例（32%）为手辅助手术。腹腔镜组1例（3%）使用了流入道阻断，开放组16例（37.2%）。腹腔镜组的平均手术时间为201 ± A 15 min，开放组为172 ± A 12 min（p = 0.1）。腹腔镜组术中平均估计失血量为122.5 +/- A 45.4 cc，开放组为299.6 +/- A 33.6 cc（p = 0.002）。两组中恶性病例的手术切缘相似。腹腔镜组的平均住院时间为3.2 +/- A 1.0天，开放组为6.8 +/- A 0.7天（p = 0.004）。腹腔镜组术后并发症发生率为13%（n = 4），开腹组为16%（n = 7（p = 0.7）。该研究表明，尽管存在学习曲线，但由于手术时间较长，腹腔镜方法在手术失血量、术后镇痛要求、定期饮食时间、住院时间和总成本相比，开放的方法为小肝切除。
Although there are data in the literature about the safety and efficacy of laparoscopic liver resections, there are not many studies comparing laparoscopic versus open approaches in a case-matched design. The purpose of this study is to compare the perioperative outcome of laparoscopic versus open liver resections from a single institution.Thirty-one patients underwent laparoscopic liver resection between April 1997 and August 2007, with a prospective laparoscopic program started in April 2006 (n = 25). This group of patients was compared with 43 consecutive patients undergoing open resection who were matched by size of the lesion (5 cm or less for malignant and 8 cm or less for benign), anatomical location (segments 2, 3, 4b, 5, 6), and type of resection (wedge resection, segmentectomy, partial liver resection). Data were obtained from medical records as well as from a prospective database. Statistical analysis was performed using t-test and chi-square. All data are expressed as mean +/- A standard error on the mean (SEM).Mean age in the laparoscopic group was 57.6 +/- A 2.7 years versus 61.9 +/- A 2.3 years in the open group (p = 0.2). There were more women in the laparoscopic group [74% females (n = 23) and 26% males (n = 8)] versus in the open group [40% females (n = 17) and 60% males (n = 26)] (p = 0.003). There were more patients with malignant lesions in the open group (73%) versus in the laparoscopic group (45%) (p = 0.01). Eight patients underwent partial and 23 patients segmental/wedge liver resection in the laparoscopic group versus 15 patients who underwent partial and 28 patients segmental/wedge liver resection in the open group (p = 0.7). Mean tumor size was 3.9 +/- A 0.4 cm in the laparoscopic group versus 4.2 +/- A 0.3 cm in the open group (p = 0.5). Ten (32%) out of 31 cases in the laparoscopic group were hand-assisted. Inflow occlusion was used in 1 case (3%) in the laparoscopic group versus 16 (37.2%) in the open group. Mean operating time was 201 +/- A 15 min for the laparoscopic group and 172 +/- A 12 min for the open group (p = 0.1). Mean estimated blood loss during the procedure was 122.5 +/- A 45.4 cc for the laparoscopic group and 299.6 +/- A 33.6 cc for the open group (p = 0.002). Surgical margin was similar for malignant cases in both groups. Mean hospital stay was 3.2 +/- A 1.0 days for the laparoscopic group and 6.8 +/- A 0.7 days for the open group (p = 0.004). The incidence of postoperative complications was 13% (n = 4) in the laparoscopic and 16% (n = 7) in the open group (p = 0.7).This study shows that, with a longer operative time, the laparoscopic approach, despite the learning curve, offers advantages regarding operative blood loss, postoperative analgesic requirement, time to regular diet, hospital stay, and overall cost compared with the open approach for minor liver resections.