静脉韧带引导下肝蒂鞘外解剖术在腹腔镜左半肝切除术中的应用价值  

Application of Extrathecal Dissection of Liver Pedicle Guided by Venous Ligament in Laparoscopic Left Hemihepatectomy

作　　者：高庆东 王小林[1] 白卫兵 GAO Qing-dong;WANG Xiao-lin;BAI Wei-bing(The First Ward of General Surgery,Yulin No.2 Hospital,Yulin 719000)

机构地区：[1]榆林市第二医院普通外科一病区,陕西榆林719000 [2]榆林市星元医院普外一科,陕西榆林719000

出　　处：《医学临床研究》2022年第1期37-40,共4页Journal of Clinical Research

摘　　要：【目的】探讨静脉韧带引导下肝蒂鞘外解剖术在腹腔镜左半肝切除术中的应用价值。【方法】选取本院2018年1月至2020年1月收治的70例需肝切除治疗患者,根据手术方案不同分为对照组和观察组,每组35例。对照组行常规鞘内解剖肝蒂技术,观察组采用静脉韧带引导下肝蒂鞘外解剖术。比较两组临床疗效及临床指标,分析两组治疗前后肝功能变化,对比两组并发症发生率。【结果】观察组总有效率为94.30%,与对照组的88.60%比较差异无统计学意义(P>0.05)。两组术后引流管拔除、胃肠功能恢复及住院各时间比较差异无统计学意义(P>0.05)。观察组手术时间、左肝蒂解剖时间及术中出血量均低于对照组(P<0.05)。两组治疗后谷本转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)水平较治疗前升高(P<0.05),白蛋白(ALB)水平较治疗前降低(P<0.05),且观察组治疗后ALT、AST水平低于对照组(P<0.05),而两组ALB、TBIL水平比较差异无统计学意义(P>0.05)。观察组并发症发生率为8.55%,与对照组的11.40%比较差异无统计学意义(P>0.05)。【结论】于腹腔镜辅助下左半肝切除术中采用经静脉韧带引导的肝蒂鞘外解剖术,疗效显著,减少术中损伤,值得临床推广。【Objective】To explore the application value of hepatic pedicle extrathecal dissection guided by venous ligament in laparoscopic left hemihepatectomy.【Methods】A total of 70 patients requiring liver resection in our hospital from January 2018 to January 2020 were divided into the control group and the observation group according to the surgical plan,with 35 cases in each group.The control group underwent conventional intrathecal anatomy of the liver pedicle,and the observation group underwent extrathecal anatomy of the liver pedicle under the guidance of venous ligament.The clinical efficacy and clinical indicators of the two groups were compared and the changes of liver function before and after treatment were analyzed.and Incidence of complications in the two groups were compared as well.【Results】The total effective rate of the observation group was 94.30%,which was not statistically different from the 88.60%of the control group(P>0.05).There was no statistically significant difference between the two groups of postoperative drainage tube removal,gastrointestinal function recovery and hospitalization time(P>0.05).The operation time,left liver pedicle dissection time and intraoperative blood loss in the observation group were lower than those in the control group(P<0.05).After treatment,the levels of ALT,AST and TBIL in the two groups were higher than before treatment(P<0.05),while the level of ALB was lower than before treatment(P<0.05).ALT and AST levels in the observation group after treatment were lower than those in the control group(P<0.05).There was no significant difference in the levels of ALB and TBIL compared with the control group(P>0.05).The incidence of complications in the observation group was 8.55%,which was not statistically different from 11.40%in the control group(P>0.05).【Conclusion】In the laparoscopic-assisted left hemihepatectomy,the transvenous ligament-guided hepatic pedicle extrathecal anatomy has a significant effect,which reduces intraoperative injuries.It is worthy of p

关 键 词：肝切除术 腹腔镜检查 韧带 肝/解剖学和组织学 

分 类 号：R657.3[医药卫生—外科学]