摘要
目的 介绍一种自制腹腔镜胃癌根治术中拨肝装置，并评估其临床应用效果。
方法 回顾性分析2014年3月至2017年1月间在南方医科大学附属南方医院接受腹腔镜胃癌根治术的469例患者的临床资料，术中为解决因肝叶的遮挡导致胃小弯侧和结肠肝曲术野暴露困难的问题，采用自制腹腔镜胃癌根治术中拨肝装置拨开肝脏。拨肝装置的制作：根据肝左叶大小，剪取两段合适长度的等长红橡胶导尿管；将带线荷包缝合针贯穿两段红橡胶导尿管，并使其置于带线荷包缝合针中间。术中利用持针器夹持预先制作好的拨肝装置通过12 mm Trocar孔送入腹腔内，置放于预先游离的肝胃韧带处，利用结扎血管夹固定两段红橡胶导尿管间的缝合线于游离肝胃韧带的肝侧位置。通过复习手术视频，评估该拨肝装置的术中应用效果。
结果 腹腔镜胃癌根治术中应用该自制拨肝装置的平均拨肝用时为40.3 s，拨肝过程中无一例出现肝脏滑落。术中需要助手再次手动拨肝次数平均2次。3例患者在拨肝过程中出现肝脏轻微损伤。
结论 自制腹腔镜胃癌根治术中拨肝装置的操作方法简单，取材方便，安全性高，手术区域暴露效果佳。
Objective To introduce the application and clinical effect of self-made liver fixing device in laparoscopic radical gastrectomy.Methods Clinical data of 469 patients underwent laparoscopic radical gastrectomy in Nanfang Hospital, Southern Medical University from March 2014 to January 2017 were analyzed retrospectively. In laparoscopic radical gastrectomy, self-made liver fixing device was used to expose surgical field covered by hepatic lobe in gastric lesser curvature and hepatic flexure of colon. Manufacture of the self-made liver fixing device： appropriate length of the catheter was cut according to the size of liver; the lotus suture needle with a thread was put through two catheters to connect them. Then the prepared liver fixing device was sent into abdominal cavity through a 12-mm Trocar hole with needle holder and was fixed on the free hepatic lateral hepatogastric ligament with hemo-lock. Finally the application effect of the liver fixing device was evaluated by reviewing the surgical videos.Results A mean time of 40.3 seconds was required to complete liver fixing by using the self-made liver fixing device in laparoscopic radical gastrectomy and liver did not slip down in all the cases. Liver secondary manual fixing by assistants was 2 times averagely. Three cases had mild liver injury.
Conclusion The self-made liver fixing device in laparoscopic radical gastrectomy is easy to operate and can effectively expose sufficient surgical field, with high security and convenient materials.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2017年第8期884-886,共3页
Chinese Journal of Gastrointestinal Surgery
基金
2016年国家级、省级、校级大学生创业实践项目（201612121045）
关键词
腹腔镜
胃癌根治术
肝脏固定
Laparoscopy
Radical gastrectomy
Liver fixing
