Laennec膜与模式化入路腹腔镜肝左外叶切除的临床对比研究  

A clinical comparative study on the Laennec’s approach versus the two-step separation stylized approach in laparoscopic left lateral sectionectomy

作　　者：陆昌友 徐云柯 郑瑗 李春桃 郭勇 方超 Lu Changyou;Xu Yunke;Zheng Yuan;Li Chuntao;Guo Yong;Fang Chao(Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属中医医院肝胆胰外科,泸州646000

出　　处：《中华肝胆外科杂志》2023年第1期49-53,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：四川省科技攻关项目(22ZDYF3796)。

摘　　要：目的比较Laennec膜与模式化入路行腹腔镜肝左外叶切除术(LLLS)的临床效果。方法前瞻性选择2019年3月至2022年4月西南医科大学附属中医医院肝胆胰外科收治的60例行LLLS患者为研究对象,其中男性40例,女性20例,年龄(49.1±9.3)岁。60例患者中肝癌31例、肝血管瘤14例、肝内胆管结石15例。采用随机数字表随机分为Laennec膜入路组(n=30)和模式化组(n=30,手术入路采用"两步分层法")。比较两组年龄、性别、肝功能Child-Pugh分级、手术时间、术中出血量、腹腔引流量、引流管留置时间、术后住院时间、住院总费用、术后并发症等。结果两组性别、年龄、肝功能Child-Pugh分级等术前指标比较,差异均无统计学意义(均P>0.05)。两组术中出血量、术后住院时间、术后并发症、术后复发等比较,差异均无统计学意义(均P>0.05)。模式化组手术时间(85.6±24.5)min少于Laennec膜入路组(99.1±30.7)min,Laennec膜入路组腹腔引流量(144.1±38.3)ml、引流管留置时间(2.7±1.5)d、住院总费用(35100.7±13200.6)元,低于模式化组(290.9±59.5)ml、(4.3±1.9)d、(44700.1±11800.8)元,差异均有统计学意义(均P<0.05)。结论腹腔镜下Laennec膜与模式化入路行肝左外叶切除均安全可行。模式化入路可以更快速切除肝左外叶,Laennec膜入路可以更精细处理肝内外管道,减少术后渗液,降低治疗费用。Objective To compare the clinical outcomes of the Laennec’s approach versus the two-step separation stylized approach in laparoscopic left lateral sectionectomy(LLLS).Methods A total of 60 patients who underwent LLLS at the Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from March 2019 to April 2022 were prospectively entered into this study.There were 40 males and 20 females,aged(49.1±9.3)years,with 31 patients suffering from liver cancer,14 patients hepatic hemangioma and 15 patients hepatolithiasis.A randomized number table was used to assign the patients into two groups:the Laennec’s approach group(n=30)and the two-step separation stylized approach group(n=30).The age,gender,liver function,operation time,intraoperative blood loss,abdominal drainage amount,drainage tube retention time,postoperative hospital stay,total hospital costs and postoperative complications were compared between the two groups.Results There were no significant differences between the two groups in gender,age and Child-Pugh grading of liver function(all P>0.05).Comparison of intraoperative bleeding,postoperative hospital stay,postoperative complications,postoperative recurrence between the two groups showed there were no significant differences between the two groups(all P>0.05).The operative time[(85.6±24.5)min vs(99.1±30.7)min,P<0.05]was significantly less in the stylized group than the Laennec’s group,while the Laennec’s group were superior to the stylized group in the amount of draining[(144.1±38.3)ml vs(290.9±59.5)ml],drainage tube retention time[(2.7±1.5)d vs(4.3±1.9)d]and total hospital costs[(35100.7±13200.6)yuan vs(44700.1±11800.8)yuan](all P<0.05).Conclusions Both the Laennec’s and stylized approaches for LLLS were safe and feasible.The stylized approach for LLLS could be performed more quickly,while the Laennec’s approach could more accurately dissect and handle intrahepatic and extrahepatic ducts,thus resulting in dec

关 键 词：肝切除术 腹腔镜检查 Laennec膜 手术入路 

分 类 号：R657.3[医药卫生—外科学] R735.7[医药卫生—临床医学]