不同入路在左肝外叶切除术中的应用对比  

Application comparison of different approaches in left extrahepatic lobectomy

作　　者：吴兆平[1] 金煜东 彭浪 熊日晖 胡秋灵[1] WU Zhao-ping;JIN Yu-dong;PENG Lang;XIONG Ri-hui;HU Qiu-ling(The First Department of Hepatobiliary and Pancreatic Surgery,the First People′s Hospital of Jiujiang City,Jiangxi Province,Jiujiang332000,China)

机构地区：[1]江西省九江市第一人民医院肝胆胰外一科,江西九江332000

出　　处：《中国当代医药》2021年第21期84-87,共4页China Modern Medicine

基　　金：江西省九江市科技计划项目(201722)。

摘　　要：目的比较不同入路在左肝外叶切除术中的应用效果。方法选取2017年3月—2020年4月九江市第一人民医院需行左肝外叶切除术治疗的82例患者作为研究对象,按随机数字表法将其分为A组与B组,每组各41例。A组患者采用经第一肝门入路手术,B组患者采用经肝圆韧带裂入路。比较两组患者的手术相关指标及术前、术后1 d时创伤应激指标、术后3个月时肝功能[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肝细胞生长因子(HGF)、总胆红素(TBil)、白蛋白(ALB)]。结果两组患者的手术时间比较,差异无统计学意义(P>0.05);B组患者的术中出血量少于A组,差异有统计学意义(P<0.05)。术后1 d,两组患者的肾上腺素、白细胞介素-6(IL-6)、皮质醇(Cor)、降钙素原(PCT)水平均高于术前,且B组患者的肾上腺素、IL-6、Cor、PCT水平低于A组,差异有统计学意义(P<0.05)。术后3个月,两组患者的ALT、AST、TBil水平均低于术前,HGF、ALB水平高于术前,且B组患者的HGF水平高于A组,差异有统计学意义(P<0.05)。术后3个月,两组患者的ALT、AST、TBil、ALB水平比较,差异无统计学意义(P>0.05)。结论与经第一肝门入路比较,采用经肝圆韧带裂入路可减少左肝外叶切除术患者的术中出血量,降低机体创伤应激反应,促进肝功能恢复。Objective To compare the effect of different approaches in left extrahepatic lobectomy.Methods A total of 82 patients who needed to undergo left extrahepatic lobotomy in the First People′s Hospital of Jiujiang City from March 2017 to April 2020 were selected as the research subjects.According to random number table method,they were divided into group A and group B,with 41 cases in each group.Group A used the first hepatic portal approach,and group B used the transhepatic round ligament approach.The operation-related indexes,traumatic stress index before and 1 d after operation,liver function(alanine aminotransferase[ALT],aspartate aminotransferase[AST],hepatocyte growth factor[HGF])before and 3 months after operation were compared between the two groups.Results There was no statistically significant difference in operation time between the two groups(P>0.05).The intraoperative blood loss in group B was lower than that in group A,and the difference was statistically significant(P<0.05).1 day after surgery,the levels of adrenaline,interleukin-6(IL-6),cortisol(Cor)and procalcitonin(PCT)in the groups were higher than those before surgery,and the levels of adrenaline,IL-6,Cor and PCT in group B were lower than those in group A,and the differences were statistically significant(P<0.05).3 months after surgery,the levels of ALT,AST and TBil in the groups were lower than those before surgery,while the levels of HGF and ALB were higher than thise before surgery,and the level of HGF in group B was higher than that in group A,and the differences were statistically significant(P<0.05).3 months after operation,there were no statistically significant differences in ALT,AST,TBil and ALB levels between the two groups(P>0.05).Conclusion Compared with the first hepatic portal approach,the transhepatic round ligament fissure approach can reduce the amount of intraoperative blood loss in patients undergoing left extrahepatic lobectomy and promote the recovery of liver function.

关 键 词：左肝外叶切除术 经第一肝门入路 经肝圆韧带裂入路 肝功能 

分 类 号：R657.3[医药卫生—外科学]