一项比较腹腔镜微波消融与腹腔镜肝切除治疗肝脏大血管瘤的匹配病例研究并文献复习
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A matched case ⁃ control study and literature review comparing laparoscopic microwave ablation and laparoscopic hepatectomy for the treatment of giant hepatic hemangioma
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    摘要:

    目的:通过比较腹腔镜微波消融与腹腔镜肝切除治疗肝脏大血管瘤的临床数据和文献复习,探讨肝脏大血管瘤的治疗策略。方法:2020年1月—2022年12月共18例患者于南京医科大学第一附属医院确诊肝脏大血管瘤并行腹腔镜下血管瘤微波消融术。以血管瘤大小、部位、体重指数为配对条件,选取18例同期行腹腔镜下血管瘤切除患者进行1∶1配对的病例对照研究。比较两组患者手术用时、术中出血量、术后并发症、术后住院时间及术后第1天肝功能[丙氨酸氨基转移酶(alanine transaminase,ALT),天门冬氨酸氨基转移酶(aspartate transaminase,AST)和总胆红素(total bilirubin,TBIL)],近远期并发症,预后等结果。结果:腹腔镜微波消融组患者手术时间低于腹腔镜手术组(P < 0.001),术中出血量低于腹腔镜手术组(P < 0.001),术后住院时间低于腹腔镜手术组(P < 0.001)。两组患者在术后不良反应率(P > 0.05),术后第1天肝功能(ALT、AST、TBIL)比较差异均无统计学意义(P > 0.05)。术后随访两组患者均未见中远期并发症。结论:腹腔镜微波消融治疗肝血管瘤效果确切,手术安全,并且能显著减少术中出血,缩短手术时间和术后住院时间。

    Abstract:

    Objective:To compare the clinical outcome and literature review of laparoscopic microwave ablation and laparoscopic hepatectomy for the treatment of giant hepatic hemangioma,and explore the treatment strategiesgiant hepatic hemangioma. Method: From January 2020 to December 2022,a total of 18 patientsdiagnosed with giant hepatic hemangiomaunderwent laparoscopic vascular tumor microwave ablation at the First Affiliated Hospital of Nanjing Medical University. Based on the size,location,and body mass index of the hemangioma,18 patients who underwent laparoscopic hemangioma resection duringthe same period were selected for a 1∶ 1 matched case-control study. The surgical duration,intraoperative blood loss,postoperative complications,postoperative hospital stay, andpostoperative liver function[alanine transaminase(ALT),aspartate transaminase(AST),and total bilirubin(TBIL)]on the first day were compared between two groups of patients,as well as the short -term and long -term complicationsand prognosis. Results:The surgical duration in the laparoscopic microwave ablation group was shorter than that in the laparoscopic surgery group(P < 0.001),the intraoperative blood loss was lower than that in the laparoscopic surgery group(P < 0.001),and the postoperative hospital stay was shorter than that in the laparoscopic surgery group(P < 0.001). There were no significant difference in the incidence of postoperative adverse reaction(P > 0.05),postoperative liver function on the first day after surgery(ALT,AST,TBIL,P > 0.05)between the two groups. No midium-term or long-term complications were observedduring the follow-up period after surgery in both groups. Conclusion:Laparoscopic microwave ablation is an effective and safe treatment for giant liverhemangioma,and it can significantly reduce intraoperative blood loss,surgical duration,and postoperative hospital stay.

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张龙,韩国勇,陈志强,张峰,吴金道.一项比较腹腔镜微波消融与腹腔镜肝切除治疗肝脏大血管瘤的匹配病例研究并文献复习[J].南京医科大学学报(自然科学版),2023,(12):1737-1742

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  • 收稿日期:2023-08-30
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  • 在线发布日期: 2023-12-12
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