前入路联合绕肝提拉法腹腔镜右肝巨大肿瘤切除术临床疗效研究  

A single-center clinical study of laparoscopic resection of large right liver tumor through standardized anterior approach

作　　者：李磊[1] 周晓春[1] 李向利[1] 许磊 姚一舟[2] 张睿 Li Lei;Zhou Xiaochun;Li Xiangli;Xu Lei;Yao Yizhou;Zhang Rui(Department of Liver and Gall Surgery,Suzhou Xiangcheng People's Hospital,Suzhou Jiangsu Province 215131,China;Department of General Surgery,the First Affiliated Hospital of Soochow University,Suzhou Jiangsu Province 215000,China)

机构地区：[1]苏州市相城人民医院肝胆外科,江苏苏州215131 [2]苏州大学附属第一医院普通外科,江苏苏州215000

出　　处：《中华普外科手术学杂志（电子版）》2022年第6期635-638,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：苏州市“科教兴卫”青年科技项目(KJXW2018001)。

摘　　要：目的:探究腹腔镜前入路联合绕肝提拉法右半肝切除术在右肝巨大肿瘤中的应用安全性。方法:回顾性纳入2016年1月至2020年1月行腹腔镜右半肝切除术治疗的右肝巨大肿瘤患者55例。根据术中是否采用绕肝提拉法分为联合组(n=25例)和常规组(n=30例),其中联合组25例行前入路联合绕肝提拉法,常规组30例行前入路法。采用SPSS 21.0软件进行数据分析,围手术期相关指标和肝功能指标等计量资料采用(x±s)表示,组间比较行独立样本t检验;术后并发症等计数资料采用例数(百分比)表示,组间比较行χ^(2)检验。P<0.05为差异有统计学意义。结果:两组患者均顺利完成手术,无中转开腹或死亡病例。联合组手术时间、术中出血量均优于常规组(P<0.05);联合组并发症总发生率低于常规组(P<0.05);术后3 d两组患者肝功能指标谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)水平较术前明显升高,至术后7 d时逐渐降低,两组间比较差异无统计学意义(P>0.05)。结论:右肝巨大肿瘤患者行腹腔镜前入路联合绕肝悬吊法右半肝切除术治疗可充分显露术野,利于血管走行观察,减少血管损伤、出血发生,是一种安全可行的术式。Objective To explore the safety of right hemihepatectomy by laparoscopic anterior approach combined with circumhepatic lifting in patients with huge right liver tumors.Methods From January 2016 to January 2020,55 patients with huge right liver tumors who underwent laparoscopic right hemihepatectomy were retrospectively enrolled.The patients were divided into the combined group(n=25)and the conventional group(n=30)according to whether the method of lifting around the liver was used during the operation.Among them,25 patients in the combined group received the anterior approach combined with the method of lifting around the liver,while 30 patients in the conventional group received the anterior approach.SPSS 21.O software was used for data analysis.Perioperative indicators and liver function indicators were represented by(x±s),and independent sample t test was used for comparison between groups.Postoperative complications and other counting data were expressed as the number of cases(percentage),and comparison between groups was performed byχ^(2)test.P<0.05 was considered statistically significant.Results The operation was successfully completed in both groups without conversion to open surgery or death.The operation time and intraoperative blood loss of the combined group were better than those of the conventional group(P<0.05).The total incidence of complications in the combined group was lower than that in the conventional group(P<0.05).The levels of AST,ALT and TBIL in the two groups were significantly increased 3 days after operation,and gradually decreased 7 days after operation,and there was no significant difference between the two groups(P>0.05).Conclusion Laparoscopic anterior approach combined with suspension around the liver for right hemihepatectomy for patients with huge right liver tumors can fully expose the operative field,facilitate the observation of the course of blood vessels,reduce vascular injury and bleeding,and is a safe and feasible surgical method.

关 键 词：肝肿瘤 肝切除术 腹腔镜 前入路 绕肝悬吊法 

分 类 号：R735.7[医药卫生—肿瘤]