经脐单孔腹腔镜肝左外叶切除术治疗肝脏良性肿瘤效果观察  

Left hepatic lobectomy under single-port transumbilical laparoscopy in the treatment of benign liver tumors

作　　者：冯丽[1] 吴硕东[1] FENG Li;WU Shuo-dong(Department of General Surgery, Shengjing Hospital Affiliated to China Medical University, Shenyang 110004, China)

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：《中华实用诊断与治疗杂志》2018年第6期564-566,共3页Journal of Chinese Practical Diagnosis and Therapy

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(2013225049)

摘　　要：目的探讨经脐单孔腹腔镜肝左外叶切除术治疗肝脏良性肿瘤的疗效及安全性。方法 78例肝脏良性肿瘤患者,依据手术方式分为观察组40例和对照组38例,观察组行经脐单孔腹腔镜肝左外叶切除术,对照组行传统腹腔镜下肝左外叶切除术,记录2组手术时间、术中出血量、肛门排气时间、术后腹腔引流时间、住院时间,以及肺部感染、胆漏、膈下积液、切口感染等并发症发生情况,分别于术前及术后14d检测谷丙转氨酶(glutamic-pyruvic transaminase,GPT),谷草转氨酶(glutamic-oxaloacetic transaminase,GOT)水平,并进行比较。结果2组手术均成功,术中未发生严重并发症;观察组术中出血量[(59.20±31.09)mL]较对照组[(179.24±27.34)mL]少,肛门排气时间[(5.67±0.78)d]、术后腹腔引流时间[(1.54±0.78)d]、住院时间[(7.45±2.18)d]较对照组[(8.34±0.34)d、(3.76±0.76)d、(12.76±2.76)d]短(P<0.05),手术时间[(128.45±43.22)min]与对照组[(118.45±29.53)min]比较差异无统计学意义(P>0.05);观察组住院期间发生胆漏1例,膈下积液1例,对照组发生肺部感染2例,胆漏2例,膈下积液2例,切口感染3例,观察组并发症发生率(5.0%)低于对照组(23.7%)(P<0.05);观察组术后14 d血清GPT[(87.53±20.09)u/L]、GOT[(83.98±23.22)u/L]水平高于术前[(39.11±3.24)、(36.89±4.22)u/L](P<0.05);对照组术后14d血清GPT[(118.45±29.53)u/L]、GOT[(113.34±45.87)u/L]水平高于术前[(38.45±2.34)、(37.91±3.13)u/L](P<0.05),且高于观察组术后14d(P<0.05)。结论肝脏良性肿瘤患者行经脐单孔腹腔镜肝左外叶切除术安全、有效,可缩短住院时间,减少术中出血量,加快肝功能恢复。Objective To evaluate the effect and safety of left hepatic lobectomy under single-port transumbilical laparoscopy in the treatment of benign liver tumors.Methods Seventy-eight patients with benign liver tumors were divided into observation group（n=40）and control group（n=38）according to the operation method.Observation group underwent left hepatic lobectomy under transumbilical single-port laparoscopy,and control group underwent traditional laparoscopic left hepatic lobectomy. The operation lasting time,intraoperative blood loss,anal exhaust time,postoperative abdominal drainage time,hospitalization stay,pulmonary infection,bile leakage,subphrenic effusion,incision infection and other complications were recorded,and the levels of glutamic-pyruvic transaminase（GPT）and glutamic-oxaloacetic transaminase（GOT）were detected and compared before and 14 days after operation.Results All operations were performed successfully in both groups,with no severe complications during the operation.The intraoperative blood loss was significantly less,and the anal exhaust time,postoperative abdominal drainage time and hospitalization stay were significantly shorter in observation group（（59.20±31.09）mL,（5.67±0.78）d,（1.54±0.78）d,（7.45±2.18）d）that those in control group（（179.24±27.34）mL,（8.34±0.34）d,（3.76±0.76）d,（12.76±2.76）d）（P〈0.05）,while there was no significant difference in the operation lasting time between two groups（（128.45±43.22）min vs（118.45±29.53）min）（P〉0.05）.The complications included 1 case of bile leakage and 1 case of subphrenic effusion in observation group and 2 cases of pulmonary infection,2 cases of bile leakage,2 cases of subphrenic effusion and 3 cases of incision infection in control group during hospital ization stay.The incidence of complications was significantly lower in observation group（5.0%）than that in control group（23.7%）（P〈0.05）.The serum levels of GPT and GOT were significantly higher 14 days after ope

关 键 词：肝脏良性肿瘤 经脐单孔腹腔镜 肝左外叶切除术 肝功能 

分 类 号：R735.7[医药卫生—肿瘤]