切割闭合器在经脐单孔腹腔镜肝左外叶切除术中的应用价值  

Application value of cutter stapler in transumbilical single port laparoscopic left lateral lobectomy

作　　者：吴硕东[1] 姚殿波[1] 于宏[1] 于晓鹏[1] 

机构地区：[1]中国医科大学附属盛京医院普通外科,沈阳110004

出　　处：《中华消化外科杂志》2016年第9期913-917,共5页Chinese Journal of Digestive Surgery

基　　金：辽宁省省直医院改革重点临床科室诊疗能力建设项目（LNCCC-A05-2014）

摘　　要：目的探讨切割闭合器在经脐单孔腹腔镜肝左外叶切除术中的应用价值。方法采用回顾性队列研究方法。收集2010年1月至2016年2月中国医科大学附属盛京医院收治的26例行经脐单孔腹腔镜肝左外叶切除术患者的临床资料。9例患者应用超声刀切割肝实质设为超声刀组，17例患者应用切割闭合器切割肝实质设为切割闭合器组。观察指标：（1）手术情况：手术时间、术中出血量、术后并发症发生情况、术后肠功能恢复时间、术后腹腔引流管拔除时间及术后住院时间。（2）术后复查及随访情况：术后患者必要时行超声或CT检查，观察有无局部渗出或包裹性积液形成。所有患者术后1-3个月采用电话方式进行随访，随访内容包括有无腹胀、腹痛不适等临床症状，随访时间截至2016年3月。正态分布的计量资料以i±s表示，采用t检验；偏态分布的计量资料以肘（范围）表示，采用秩和检验；计数资料比较采用Fisher确切概率法。结果（1）手术情况：26例患者均顺利完成经脐单孔腹腔镜肝左外叶切除术，无中转多孔或开腹手术。26例患者手术时间为（114±54）min，术中出血量为100（20～800）mL，均无术中输血。超声刀组患者于术时间为（135±43）min，术中出血量为200（20～800）mL，切割闭合器组患者手术时间为（1034-57）min，术中出血量为100（20～300）mL，两组患者上述指标比较，差异均无统计学意义（t=1．500，Z==0．961，P〉0．05）。两组患者术后均恢复顺利，无术后出血、胆汁漏、切口感染等并发症发生，无死亡病例。超声刀纰患者术后肠功能恢复时间、术后腹腔引流管拔除时间及术后住院时间分别为（1．5±0．4）d、（5．8±2．0）d和（7．0±2．0）d，切割闭合器组为（1．1±0．3）d、（4．1±1．1）d和（4．9±1．4）d，两组患者上述指标比较，差异均有统计学意�Objective To investigate application value of cutter stapler in transumbilical single port laparoscopie left lateral lobectomy, Methods The retrospective cohort study was adopted. The clinical data of 26 patients who underwent transumbilical single port laparoscopic left lateral lobectomy at the Shengjing Hospital of China Medical University from January 2010 to February 2016 were collected. Nine patients who received liver parenchyma using ultrasonic knife were allocated into the uhrasonic knife group, 17 patients who received liver parenchyma using cutter stapler were allocated into the cutter stapler group. Observation indicators included （ 1 ） operation situations： operation time, volume of intraoperative blood loss, postoperative complications, time of postoperative bowel function recovery, time of abdominal cavity drainage tube removal, duration of postoperative hospital stay. （2） Postoperative reexamination and follow-up： ultrasound or computed tomography （CT） examination was perfomled when necessary for detecting local exudation or encapsulated effusion. The patients were followed up at postoperative I to 3 months with telephone interview for whether with abdominal distension or abdominal pain till March 2016. Measurement data with normal distribution were presented as x± s and analyzed by using t test. Measurement data with skewed distribution were presented as M （range） and analyzed by rank- sum text. Comparison of count data was analyzed by the Fisher＇ s exact probility. Results （ 1 ） Operation situations： all the 26 patients received transumbilical single port laparoscopic left lateral lobectomy with no conversion to porous laparoscopic surgery or open surgery. The operation time was （ 114 ± 54） minutes, the volume of intraoperative blood loss was 100 mL （range, 20-800 mL）, and no intraoperative blood transfusion was adopted. The operation time and volume of intraoperative blood loss were （135 ± 43 ）minutes and 200 mL （range, 20-800 mL） in the ultrasonic

关 键 词：肝脏疾病 肝切除术 切割闭合器 腹腔镜检查 单孔 

分 类 号：R657.3[医药卫生—外科学]