经“肝脏第三扇门”入路在解剖性右肝切除术中的应用  

Application of "the third gate of the liver" approach in anatomic right hepatectomy

作　　者：邢时龙 孙亭立[1] 胡莉红[1] XING Shilong;SUN Tingli;HU Lihong(Department of Hepatobiliary and Pancreatic Surgery,JiuJiang NO.1 People's Hospital,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科,江西九江332000

出　　处：《中国当代医药》2024年第26期35-38,共4页China Modern Medicine

基　　金：江西省卫生健康委科技计划项目(202311466)。

摘　　要：目的探讨经“肝脏第三扇门”入路在解剖性右肝切除术中的应用价值。方法选取2022年6月至2024年3月在九江市第一人民医院择期行解剖性右肝叶切除术治疗的60例患者作为研究对象,根据随机数字表法分为对照组(n=30)和试验组(n=30)。两组患者均在气管插管全身麻醉下行解剖性右肝叶切除术治疗,其中试验组行“经肝脏第三扇门”入路,对照组行常规入路。比较两组患者围手术期指标、肝肾功能指标[丙氨酸转氨酶(ALT)、白蛋白(ALB)、总胆红素(TBil)、尿素氮(BUN)]、血乳酸值、并发症。结果试验组术中出血量、住院费用低于对照组,住院时间、切肝时间短于对照组,差异有统计学意义(P<0.05);两组患者术后病理切缘阳性率比较,差异无统计学意义(P>0.05);术后,两组患者ALT、TBil、BUN、血乳酸均高于本组术前,ALB检测值低于本组术前,而试验组ALT、TBil、BUN、血乳酸检测值低于对照组,ALB检测值高于对照组,差异有统计学意义(P<0.05);两组患者术后出血、胆漏发生率比较,差异无统计学意义(P>0.05);试验组术中肝静脉损伤发生率低于对照组,差异有统计学意义(P<0.05)。结论解剖性右肝切除术中采用经“肝脏第三扇门”入路可缩短切肝时间,减小手术创伤,降低肝静脉损伤发生率,降低对肝肾功能损害,促进患者病情恢复,减轻经济负担。Objective To evaluate the application value of"the third gate of the liver"approach in anatomic right hepatectomy.Methods A total of 60 patients who underwent anatomic right hepatectomy in JiuJiang NO.1 People's Hospital from June 2022 to March 2024 were selected as the research objects,and they were divided into control group(n=30)and experimental group(n=30)according to random number table method.Both groups were treated with anatomic right hepatectomy under tracheal intubation and general anesthesia.The experimental group was treated with"the third gate of the liver"approach and the control group was treated with the conventional approach.The perioperative indexes,liver and kidney function indexes(alanine transaminase[ALT],albumin[ALB],total bilirubin[TBil],blood urea nitrogen[BUN]),blood lactic acid values and complications were compared between the two groups.Results The intraoperative blood loss and hospitalization cost of experimental group were lower than those of control group,and the hospitalization time and hepatectomy time of experimental group were shorter than those of control group,with statistical significances(P<0.05).There was no significant difference in the positive rate of postoperative pathological margin between the two groups(P>0.05).After operation,ALT,TBil,BUN and blood lactic acid in two groups were higher than those before operation,ALB detection values were lower than those before operation,while ALT,TBil,BUN and blood lactic acid detection values in experimental group were lower than those of control group,ALB detection value was higher than that of control group,the differences were statistically significant(P<0.05).There were no significant differences in the incidences of postoperative bleeding and bile leakage between the two groups(P>0.05).The incidence of intraoperative hepatic vein injury in experimental group was lower than that in control group,and the difference was statistically significant(P<0.05).Conclusion The use of"the third gate of the liver"approach in anatomic righ

关 键 词：解剖性右肝切除术 解剖 肝肾功能 “肝脏第三扇门” 围手术期 

分 类 号：R657.3[医药卫生—外科学]