摘要
目的探讨腹腔镜下减重手术中克氏针挡肝技术的可行性及安全性。方法2019年1~9月我科在110例减重手术中采用克氏针挡肝技术完成肝脏牵拉:腹腔镜直视下以克氏针在剑突下2 cm左侧穿刺腹壁,肠钳挑起肝脏后将克氏针经肝下置于膈肌脚从而抬起肝脏、暴露术野。结果110例克氏针挡肝技术均获得良好的术野暴露,无须其他肝脏牵拉技术。完成克氏针挡肝时间(34.4±10.1)s,手术时间(88.2±28.0)min,术中出血中位数20(10,50)ml。术中均未发现肝刺裂伤、肝包膜下血肿等并发症。术后均未发现穿刺点再出血、感染等克氏针挡肝技术相关并发症,均未出现吻合口出血、胃漏及吻合口漏等严重手术并发症。术后住院时间(3.6±1.2)d,住院费用(62383.7±10021.2)元。术前ALT、AST分别为44.0(25.8,71.8)U/L、28.0(19.0,45.3)U/L,显著低于术后第1天AST、ALT分别为51.5(30.8,83.0)U/L、41.0(26.0,63.5)U/L(P均=0.000);术后1个月ALT、AST分别为42.5(29.0,67.0)U/L、29.0(22.0,43.0)U/L,与术前比较差异均无显著性(P=0.634,P=0.784)。结论在减重手术中,克氏针挡肝技术安全、可行,可以作为一种常规的肝脏牵拉技术。
Objective To explore the safety and feasibility of the k-wire liver retracting technique during obesity surgery.Methods A retrospective review was performed on 110 patients undergoing obesity surgery from January 2019 to September 2019.The K-wire was used to retract the left lobe of liver in all the cases.The k-wire was introduced leftwards at 2 cm inferior to the xiphoid under laparoscopic visualization.The liver was retracted anterior to the abdominal wall by bowel clamp and then the k-wire was directed underneath the liver at the diaphragmatic crura to expose the operative field.Results The k-wire liver retracting technique could maintain an adequate operative field in all the cases,without convention to other liver retracting techniques.It took(34.4±10.1)seconds to finish the liver retracting technique.The mean operating time was(88.2±28.0)minutes,and the median operative bleeding was 20(10,50)ml.No case of puncture-site related bleeding or infection happened.And no case of anastomotic bleeding or leakage happened.The postoperative hospital stay was(3.6±1.2)days,and the total hospitalization costs were(62383.7±10021.2)yuan.The ALT and AST levels of 110 patients were 44.0(25.8,71.8)U/L and 28.0(19.0,45.3)U/L before operation and 51.5(30.8,83.0)U/L and 41.0(26.0,63.5)U/L on the first day postoperatively and 42.5(29.0,67.0)U/L and 29.0(22.0,43.0)U/L at the first month postoperatively,respectively,with statistically significant differences between before operation and on the first day(all P=0.000),and no statistical significant differences between before operation and at the first month postoperatively(P=0.634,P=0.784).Conclusion The k-wire liver retracting technique is safe and feasible in obesity surgery,and it can be used as a routine liver retracting technique.
作者
郑学静
桑庆
王亮
陈冠阳
张能维
Zheng Xuejing;Sang Qing;Wang Liang(Surgery Centre of Diabetes Mellitus, Ninth Clinical Hospital, Peking University, Beijing 100038, China)
出处
《中国微创外科杂志》
CSCD
北大核心
2020年第8期700-703,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
肝左外叶
克氏针
减重手术
肝脏牵拉技术
Left lateral lobe of liver
K-wire
Obesity surgery
Liver retracting technique
