“2步分层法”腹腔镜左外叶肝切除的解剖学基础和临床应用  

The anatomical study and clinical application of the two-step separation approach for laparoscopic left lateral hepatectomy

作　　者：王丹[1] 夏仁品[1] 杨世昆[1] 徐王刚[1] 段键[1] WANG Dan;XIA Ren-ping;YANG Shi-kun;XU Wang-gang;DUAN Jian(The Second Department of Hepatobiliary, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan, Chin)

机构地区：[1]昆明医科大学第一附属医院器官移植中心

出　　处：《中国临床解剖学杂志》2018年第1期82-85,共4页Chinese Journal of Clinical Anatomy

摘　　要：目的探讨肝左外叶的解剖学结构,对比＂2步分层法＂和传统法在腹腔镜左外叶肝切除中的差异。方法回顾性分析2014年6月至2017年4月期间实行＂2步分层法＂腹腔镜左外叶肝切除术的临床资料和影像学资料46例,并与2014年以前行传统腹腔镜左外叶肝切除的53例患者资料进行统计分析。结果 2组患者在性别、年龄、病程、肿瘤部位及大小、术前肝功能、肝储备功能等方面差异无统计学意义（P〉0.05）,2组患者术中失血量、术后住院时间基本接近,两组间无统计学差异（P〉0.05）;＂2步分层法＂组患者的手术持续时间明显短于对照组,差异有统计学意义（P〈0.05）。结论 ＂2步分层法＂在腹腔镜左外叶肝切除中改良不切断镰状韧带,可以减少不必要的手术操作,节省手术时间,方法简单易学,加上腹腔镜技术的发展,可使其成为左外叶肝切除的标准术式。Objective To investigate the anatomical structure of the left lateral lobe, and to compare the differences between＂the two-step separation approach＂and the traditional method in laparoscopic left lateral sectionectomy（LLLS）. Methods We retrospectively analyzed the clinical data and imaging information of 46 cases of laparoscopic left lateral lobectomy with ＂no fissure the falciform ligament of liver using two-step separation approach＂ from June 2014 to April 2017 in our hospital. Statistical analysis was performed for comparison data to patients with traditional laparoscopic left lobectomy before 2014. Results There was no significant difference between the two groups in gender, age, course of disease, location and size of tumor, preoperative liver function, liver reserve function（P〉0.05）; intraoperative blood loss, postoperative hospitalization time of patients in the two groups were close, and there was no significant difference between the two groups（P〉0.05）. The duration of operation in＂the two-step separation approach＂group was significantly shorter than that in the control group（P〈0.05）. Conclusion The modified＂The two-step separation approach＂in laparoscopic left lateral hepatectomy does not involve severance of falciform ligament, thus circumventing unnecessary operation, and reducing the operation time; The method is easy to learn and has become the gold standard for left lateral hepatectomy when taking into account the development of laparoscopic techniques.

关 键 词：分层法 腹腔镜左外叶肝切除 解剖学 

分 类 号：R322.47[医药卫生—人体解剖和组织胚胎学] R657.3[医药卫生—基础医学]