摘要
目的探讨腹腔镜半肝切除术中肝中静脉(MHV)显露的安全性及可行性。方法回顾性分析2017年6月~2019年12月南京医科大学附属常州第二人民医院肝胆胰外科行腹腔镜下半肝切除58例患者的临床资料,根据术中有无显露MHV将患者分为显露组和非显露组,对比两组患者的一般情况、手术时间、术中出血量、术后并发症、术后第3天丙氨酸氨基转移酶(ALT)、术后住院天数等指标。结果腹腔镜下半肝切除的58例患者中男性36例,女性22例,年龄22.0~75.0(49.8±12.1)岁,MHV显露组患者30例,非显露组患者28例。两组患者年龄、Child-Pugh评分、疾病谱等方面的一般资料差异无统计学意义(P>0.05)。共有3例患者中转开腹,其中显露组2例,原因为严重的CO2气体栓塞导致循环不稳和不易控制的术中出血各1例,非显露组1例为术中较多出血而中转开腹。显露组患者手术时间较非显露组手术时间长[(240.8±80.6)min比(185.8±50.6)min],差异有统计学意义(P<0.05)。显露组患者术后第3天ALT低于非显露组[(150.8±80.6)U/L比(287.6±110.2)U/L],差异具有统计学意义(P<0.05)。两组患者术中出血量、术后并发症、术后住院天数等差异均无统计学意义(P>0.05)。结论以MHV为导向的解剖性腹腔镜半肝切除是符合精准外科理念的手术方式,是安全可行的,其手术难点在于如何快速安全的找到MHV主干及出血的可靠处理。
Objective To study the safety and feasibility of exposure versus non-exposure of middle hepatic vein(MHV)in laparoscopic hemihepatectomy.Methods A retrospective study was conducted on 58 patients who underwent laparoscopic hemihepatectomy at the Department of Hepatobiliary and Pancreatic Surgery,the Second People's Hospital of Changzhou Affiliated to Nanjing Medical University from June 2017 to December 2019.According to whether MHV was exposed during operation,patients were divided into the exposed and the non-exposed groups.General condition,operation time,intraoperative blood loss,postoperative complications,alanine aminotransferase(ALT)on day 3 of surgery,postoperative hospital stay and other indicators were compared between the two groups.Results There were 36 males and 22 females,aged 22.0-75.0(49.8±12.1)years and there were 36 patients in the MHV exposure group and 28 in the non-exposed group.There were no significant differences between groups in age,Child-Pugh score,and disease spectrum(P>0.05).Three patients were converted to laparotomy,with 2 in the exposure group.The reasons for conversion were severe CO2 gas embolism causing circulatory instability(n=1)and intraoperative bleeding which was difficult to control(n=1).Of the remaining 1 patient in the non-exposed group,conversion to laparotomy was done because of intraoperative bleeding.The operation time of the exposed group was significantly longer than the non-exposed group[(240.8±80.6)min vs(185.8±50.6)min,P<0.05].The ALT of the exposed group was significantly lower than the non-exposed group on post-operative day 3[(150.8±80.6)U/L vs(287.6±110.2)U/L,P<0.05].There were no significant differences in operative blood loss,postoperative complications,and postoperative hospital stay between the two groups(P>0.05).Conclusions Exposure of MHV allowed precise anatomical hemihepetectomy and was safe and feasible.Difficulties of this operation were found to be mainly related to how to find the trunk of MHV quickly and how to deal with intraoperative hemo
作者
吴宝强
吴勇
何振飞
周海华
朱春富
秦锡虎
Wu Baoqiang;Wu Yong;He Zhenfei;Zhou Haihua;Zhu Chunfu;Qin Xihu(Department of Hepatobiliary and Pancreatic Surgery,the Second People's Hospital of Changzhou Affiliated to Nanjing Medical University,Changzhou 213000,Jiangsu Province,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2020年第12期886-890,共5页
Chinese Journal of Hepatobiliary Surgery
