腹腔镜肝左外叶切除三种血流阻断方法的比较  

Comparison of three different methods for hepatic inflow occlusion in laparoscopic left lateral hepatic lobectomy

作　　者：夏志超[1] 曾仲[1] 夏仁品[1] 杨世昆[1] 黄汉飞[1] 徐王刚[1] 林杰[1] 段键[1] 

机构地区：[1]昆明医科大学第一附属医院器官移植中心,云南昆明650032

出　　处：《中国普通外科杂志》2016年第9期1336-1340,共5页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(81360079);云南省卫生科技计划资助项目(2014NS155);云南省应用基础研究计划资助项目(2013FB142)

摘　　要：目的:探讨3种不同肝血流阻断方法在腹腔镜肝左外叶切除术中的临床效果。方法:回顾性分析2008—2015年间因原发性肝细胞癌行腹腔镜肝左外叶切除术的45例患者临床资料,患者术中肝血流控制分别采用Pringle法(全肝阻断组,18例)、半肝血流阻断法(半肝阻断组,17例)、七步断肝法分步阻断(七步断肝组,10例)。比较3组相关临床指标的差异。结果:3组术中失血量差异无统计学意义(P>0.05),但七步断肝组在手术时间、术后肝功能恢复、胃肠功能恢复、并发症发生率、住院时间等指标上明显优于全肝阻断组与半肝阻断组(均P<0.05)。结论:利用七步断肝法行腹腔镜肝左外叶切除术安全、简便、可行,且对术者腹腔镜技术要求不高,适合各级医院借鉴和开展。Objective： To compare the clinical effects of three different methods for hepatic inflow occlusion in laparoscopic left lateral hepatic lobectomy. Methods： The clinical data of 45 patients undergoing laparoscopic left lateral hepatic lobectomy for primary hepatocellular carcinoma during 2008 to 2015 were retrospectively analyzed. The intraoperative hepatic inflow control of the patients was performed by Pringle＇s maneuver （total hepatic occlusion group, 18 cases）, hemihepatic vascular occlusion （hemihepatic occlusion group, 17 cases）, and stepped occlusion of seven-step liver transection method （seven-step liver transection group, 10 cases）. The major clinical variables among the three groups of patients were compared. Results： The intraoperative blood loss showed no statistical difference among the three groups （P〉0.05）, but the operative duration, postoperative liver function recovery, gastrointestinal functional recovery, incidence of postoperative complications and length of hospital stay in seven-step liver transection group were all significantly superior to those in total hepatic occlusion group and hemihepatic occlusion group （all P〈O.05）. Conclusion. Using seven-step method in laparoscopic left lateral hepatic lobectomy is safej simple and feasible, with no special laparoscopic skill requirements for performers, so it is recommended to be used in hospitals of different levels.

关 键 词：肝肿瘤/外科学 肝切除术/方法 腹腔镜 

分 类 号：R657.3[医药卫生—外科学]