经耻骨联合上横切口与经脐周Trocar扩大切口用于腹腔镜肝切除术取出较大标本的效果比较  

A comparative study on specimen extraction via suprapubic transverse incision versus periumbilical Trocar enlargement incision in laparoscopic hepatectomy

作　　者：梁文祥 袁汉坤 游声林 周嘉杰 罗宗将 陆礼柏 黄莹[2] 汪建初[1] LIANG Wenxiang;YUAN Hankun;YOU Shenglin;ZHOU Jiajie;LUO Zongjiang;LU Libai;HUANG Ying;WANG Jianchu(Department of Hepatobiliary and Pancreatic Surgery&Obesity and Metabolic Diseases,Baidong Campus of Affiliated Hospital of Youjiang Medical University of Nationalities,Guangxi Clinical Medical Research Center for Hepatobiliary Diseases,Baise 533000,China;不详)

机构地区：[1]右江民族医学院附属医院百东院区肝胆胰&肥胖与代谢病外科、广西肝胆疾病临床医学研究中心,533000 [2]右江民族医学院

出　　处：《浙江医学》2025年第4期410-413,426,共5页Zhejiang Medical Journal

基　　金：国家自然科学基金项目(82060441);广西临床重点专科建设项目。

摘　　要：目的比较经耻骨联合上横切口与经脐周Trocar扩大切口在腹腔镜肝切除术取出较大肝脏标本的效果,并探讨两种切口在术后止痛药的使用、切口并发症及愈合情况等方面的差异。方法回顾性收集右江民族医学院附属医院2020年1月至2023年10月行腹腔镜肝切除中标本通过耻骨联合上横切口与经脐周Trocar扩大切口的患者90例,其中采用经脐周Trocar扩大切口组54例,采用经耻骨上联合横切口组36例。比较两组患者术后止痛药物使用量、切口并发症(切口感染和切口疝)、切口愈合情况等方面的差异。结果经脐周Trocar扩大切口组止痛剂曲马多使用剂量2.50(2.00,4.00)支,经耻骨联合上横切口组为2.00(1.00,3.75)支,差异有统计学意义(P<0.05)。经脐周Trocar扩大切口组中出现切口感染2例,未出现切口疝;经耻骨联合上横切口组均未出现切口感染与切口疝,出现皮下血肿1例,差异无统计学意义(P>0.05)。经脐周Trocar扩大切口组在术口愈合中出现乙级愈合3例,丙级愈合1例,其余均为甲级愈合,经耻骨联合上切口组均为甲级愈合,差异无统计学意义(P>0.05)。结论在腹腔镜肝切除术中,经耻骨联合上横切口在术后止痛药物使用量和切口愈合效果方面优于经脐周Trocar扩大切口,是一种安全、有效的较大肝脏标本取出方式。Objective To compare the effectiveness of extracting larger liver specimens via suprapubic transverse incision versus periumbilical Trocar extension incision in laparoscopic hepatectomy,and to explore the differences between the two incision methods in terms of postoperative analgesic use,incision complications,and healing outcomes.Methods A retrospective collection of 90 patients who underwent laparoscopic hepatectomy with specimen extraction via suprapubic transverse incision or periumbilical Trocar enlargement incision at the Affiliated Hospital of Youjiang Medical University for Nationalities between January 2020 and October 2023 was conducted.Among them,54 patients were in the periumbilical Trocar enlargement incision group,while another 36 patients were in the suprapubic transverse incision group.The differences in postoperative analgesic use,incision complications(incision infection and incisional hernia),and incision healing grades were compared between the two groups.Results The tramadol dosage used in the periumbilical Trocar enlargement incision group was 2.50(2.00,4.00)vials,while it was 2.00(1.00,3.75)vials in the suprapubic transverse incision group,showing a statistically significant difference(P<0.05).In the periumbilical Trocar enlargement incision group,there were 2 cases of incision infection and no incisional hernia was observed;in the suprapubic transverse incision group,there were no cases of incision infection or incisional hernia,but one case of subcutaneous hematoma,with no statistically significant difference(P>0.05).In the periumbilical Trocar enlargement incision group,there were 3 cases of grade B healing and one case of grade C healing,with the rest being grade A healing;while in the suprapubic transverse incision group,all cases were grade A healing,with no statistically significant difference(P>0.05).Conclusion In laparoscopic hepatectomy,the suprapubic transverse incision for extracting larger liver specimens is superior to the periumbilical Trocar extension incision in terms of p

关 键 词：耻骨联合上横切口 脐周Trocar扩大切口 腹腔镜肝切除术 标本取出 

分 类 号：R657.3[医药卫生—外科学]