肝左外叶翻转法用于腹腔镜胃癌根治术10例分析  

Hepatic left lateral segment inversion for laparoscopic radical gastrectomy:a report of ten patients

作　　者：颜上程 陈任维 彭巍[1] 程明 任睿 盛梦超 刘天华 陈强[1] 吴永友[1] YAN Shang-cheng;CHEN Ren-wei;PENG Wei(Department of Gastrointestinal Surgery,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院胃肠外科,江苏苏州215004

出　　处：《中国实用外科杂志》2024年第1期111-114,共4页Chinese Journal of Practical Surgery

基　　金：苏州市临床医学专家团队引进项目(No.SZYJTD201804);苏州市临床重点病种诊疗技术专项(No.LCZX202310);苏州大学第二医院医疗新技术专项助力计划项目(No.23ZL002)。

摘　　要：目的 探讨肝左外叶翻转法用于腹腔镜胃癌根治术的安全性和临床价值。方法 回顾性分析2023年9—10月苏州大学附属第二医院胃肠外科收治的行腹腔镜胃癌根治术的连续10例胃癌或食管胃结合部腺癌(adenocarcinoma of esophagogastric junction,AEG)病例的临床资料,术中均采用肝左外叶翻转法显露术野。术后观察近期疗效。结果 10例病人术中均成功完成肝左外叶翻转,操作时间为(13.7±3.5)min。所有病人均无需进行肝脏重新牵引或更改牵引方法,未发生肝脏遮挡食管裂孔,无需操作钳辅助暴露。所有病人术中未发生肝脏出血、肝静脉损伤、肝淤血等情况。术后住院时间为10.5(10~14)d,术后30 d内均未发生消化系统相关Clavien-Dindo分级≥Ⅱ级的并发症,仅2例病人出现胸腔积液。部分病人术后第1天丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)升高,第3天开始明显下降,术后第7天均下降至术前正常水平。结论 腹腔镜胃癌根治术中使用肝左外叶翻转法显露术野,效果满意,在方便手术操作、减少手术创伤、保护肝脏、降低手术费用等方面具有一定优势。Objective This study aimed to investigate the safety and clinical value of hepatic left lateral segment inversion(HLLSI)technique for laparoscopic radical gastrectomy(LRG).Methods We retrospectively analyzed the clinical data of ten consecutive patients with gastric cancer or adenocarcinoma of esophagogastric junction who underwent HLLSI for LRG from September to October,2023 at Department of Gastrointestinal Surgery,Second Affiliated Hospital of Soochow University.HLLSI was used to expose the surgical field in all patients while short-term outcomes were observed.Results HLLSI was successfully performed in all patients with a mean operating time of 13.7±3.5 min.There was no need for intraoperative re-retraction or change in retraction methods,no esophageal hiatus occlusion,no need for forceps to assist exposure,and no hepatic hemorrhage,hepatic congestion,or hepatic vein injury.Postoperative length of stay was 10.5(10-14)d.No digestive complications of Clavien-Dindo grade≥II occurred within 30 days after surgery,while only two patients had pleural effusion.Alanine aminotransferase and glutamine aminotransferase peaked at postoperative day one in some patients,but fell back significantly at postoperative day three,and returned to the preoperative level at postoperative day seven.Conclusion HLLSI technique was satisfactory for LRG in terms of field visualization,and has advantages in facilitating surgical operation,reducing surgical trauma,protecting the liver,and lowering the surgical cost.

关 键 词：肝脏牵引 食管胃结合部腺癌 腹腔镜 胃癌根治术 手术并发症 

分 类 号：R6[医药卫生—外科学]