肝圆韧带裂入路在再次肝切除手术中的应用  

Application of round ligament fissure approach in re-hepatectomy

作　　者：王清[1] 高峰畏 刘宇[1] 薛谦 付金强[1] WANG Qing;GAO Fengwei;LIU Yu;XUE Qian;FU Jinqiang(Department of Hepatopancreatobiliary Surgery,Leshan People’s Hospital,Leshan,Sichuan 614000,P.R.China)

机构地区：[1]乐山市人民医院肝胆胰腺外科,四川乐山614000

出　　处：《中国普外基础与临床杂志》2021年第2期155-159,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省医学会青年创新课题(项目编号:Q18027)。

摘　　要：目的探讨肝圆韧带裂入路在再次肝切除手术中的应用效果。方法回顾性收集2017年6月至2020年8月期间在乐山市人民医院肝胆胰腺外科行再次肝切除术的40例HCC术后复发患者,根据手术入路方式不同分为研究组(经肝圆韧带裂入路)与对照组(常规手术入路),各20例。比较2组的围手术期手术指标、外周血实验室指标及并发症发生情况。结果与对照组比较,研究组的手术时间、术后引流管拔出时间和术后住院时间均缩短,术中出血量减少(P<0.05)。同组内与术前比较,2组患者术后的TBIL、ALT水平均降低,HGF水平均升高(P<0.05)。术前2组患者的TBIL、ALT和HGF水平比较差异均无统计学意义(P>0.05);术后1个月时,2组的TBIL和ALT水平比较差异也无统计学意义(P>0.05),但术后1个月时研究组的HGF水平高于对照组,差异有统计学意义(P>0.05)。2组手术前后TBIL和ALT的差值比较差异均无统计学意义(P>0.05),但研究组术后HGF的升高值高于对照组(P<0.001)。2组患者围手术期无死亡病例,术后总并发症发生情况比较差异无统计学意义(P=0.677);随访期间2组的复发、转移和死亡情况比较差异均无统计学意义(P>0.05)。结论肝圆韧带裂入路再次肝切除可减少术中出血量,缩短手术时间,并能减小对残留肝脏的损伤,具有较高的安全性。Objective To investigate the effect of the round ligament fissure approach in re-hepatectomy.Methods A total of 40 patients with recurrence of hepatocellular carcinoma(HCC)who underwent re-hepatectomy in the Department of Hepatopancreatobiliary Surgery of Leshan People’s Hospital from June 2017 to August 2020 were collected and divided into two groups according to different surgical approaches:study group(transhepatic round ligament fissure approach)and control group(conventional surgical approach),20 cases in each group.The perioperative general indicators,peripheral blood laboratory indicators,and complications of the two groups were compared.Results Compared with the control group,the operation time,postoperative drainage tube removal time,and postoperative hospital stay of study group were shortened,and intraoperative blood loss was reduced(P<0.05).Compared with preoperatively in the same group,postoperative TBIL and ALT levels of the two groups decreased,and HGF levels increased(P<0.05).There was no significant difference in the levels of TBIL,ALT,and HGF between the two groups before surgery(P>0.05);at 1 month after surgery,there was no significant difference in the levels of TBIL and ALT between the two groups(P>0.05),but the HGF level of the study group was higher than that of the control group at1 month after operation,the difference was statistically significant(P<0.05).The changes before and after operation of TBIL and ALT were similar between the two groups(P>0.05),but the rising value of HGF in the study group was higher than that of the control group(P<0.001).There was no death in the two groups during the perioperative period,and the total postoperative complications were not statistically different(P=0.677).There was no statistically significant difference in the postoperative follow-up results between the two groups in recurrence,metastasis,and death(P>0.05).Conclusion Re-hepatectomy through the round ligament fissure approach can reduce the amount of intraoperative blood loss,shorten the opera

关 键 词：复发性肝细胞癌 肝圆韧带裂入路 再次肝切除术 肝功能 术中出血 

分 类 号：R735.7[医药卫生—肿瘤]