摘要
目的:探讨胆囊板入路(CPA)右肝蒂鞘外解剖法在微创解剖性肝切除术(MIALR)中的应用价值。方法:采用回顾性队列研究方法。收集2020年8月至2022年8月南方医科大学南方医院收治的42例原发性肝癌行腹腔镜右半肝切除术患者的临床病理资料;男36例,女6例;年龄为(55±13)岁。42例患者中,25例术中采用CPA右肝蒂鞘外解剖法,设为CPA组;17例术中采用传统入路右肝蒂鞘外解剖法,设为传统入路组。观察指标:(1)手术情况。(2)术后情况。正态分布的计量资料以x±s表示,组间比较采用t检验。偏态分布的计量资料以M(IQR)表示,组间比较采用Mann-Whitney U检验。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。等级资料比较采用非参数秩和检验。结果:(1)手术情况。两组患者均顺利完成腹腔镜右半肝切除术,切缘均为阴性。CPA组患者手术时间,术中出血量,解剖目标肝蒂时间,解剖右前肝蒂主干例数及时间,解剖右后肝蒂主干例数及时间,肝蒂损伤,肝组织损伤,解剖操作空间(大、小)分别为150.00(130.00)min,100.00(100.00)mL,472.00(201.00)s,10例,366.00(94.75)s,9例,564.00(138.50)s,2例,2例,25、0例;传统入路组患者上述指标分别为140.00(113.00)min,100.00(125.00)mL,670.00(107.00)s,8例,663.00(136.00)s,7例,783.00(189.00)s,8例,5例,2、19例;两组患者解剖目标肝蒂时间、解剖右前肝蒂主干时间、解剖右后肝蒂主干时间、肝蒂损伤、解剖操作空间比较,差异均有统计学意义(Z=-4.809、-3.254、-3.188,χ^(2)=6.493、34.314,P<0.05),手术时间、术中出血量、解剖右前肝蒂例数、解剖右后肝蒂例数、肝组织损伤比较,差异均无统计学意义(Z=-0.282、-0.412,χ^(2)=0.095、0.002、1.976,P>0.05)。(2)术后情况。两组患者均无术后出血;CPA组患者术后第3天丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、凝血酶原时间,术后胆漏,肿瘤病理学类型(肝细胞癌、肝�
Objective To investigate the application value of cystic plate approach(CPA)for extrahepatic right hepatic pedicle dissection in minimally invasive anatomical hepatectomy(MIALR).Methods The retrospective cohort study was conducted.The clinicopathological data of 42 patients with primary liver cancer who underwent laparoscopic right hemi‐hepatectomy in Nanfang Hospital of Southern Medical University from August 2020 to August 2022 were collected.There were 36 males and 6 females,aged(55±13)years.Of the 42 patients,25 cases undergoing CPA for extrahepatic right hepatic pedicle dissection were divided into the CPA group,and 17 cases undergoing traditional approach for extrahepatic right hepatic pedicle dissection were divided into the traditional approach group.Observation indicators:(1)surgical situations;(2)postoperative situations.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(IQR),and comparison between groups was conducted using the Mann‐Whitney U test.Count data were described as absolute numbers,and comparison between groups was conducted using the chi‐square test or Fisher exact probability.Comparison of ordinal data was conducted using the non‐parameter rank sum test.Results(1)Surgical situations.All patients in the two groups underwent laparoscopic right hemi‐hepatectomy successfully,with the surgical margin as negative.The operation time,volume of intraoperative blood loss,time of dissection of the targeted hepatic pedicle,cases undergoing dissection of the trunk of right anterior hepatic pedicle and its operation time,cases undergoing dissection of the trunk of right posterior hepatic pedicle and its operation time,cases with hepatic pedicle injury,cases with hepatic tissue injury,cases with dissection space as large and small were 150.00(130.00)minutes,100.00(100.00)mL,472.00(201.00)seconds,10 and 366.00(94.75)seconds,9 and 564.00(138.50)seconds,
作者
王恺
孙世波
李芷西
唐善华
王鑫
李尧
周杰
张起帆
Wang Kai;Sun Shibo;Li Zhixi;Tang Shanhua;Wang Xin;Li Yao;Zhou Jie;Zhang Qifan(Department of Hepatobiliary and Pancreatic Surgery,General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2023年第4期489-496,共8页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金(82170647、82070642)
广东省自然科学基金(2021A1515012485、2021A1515011015)。
关键词
肝肿瘤
肝切除
肝蒂鞘外解剖
微创解剖性肝切除
Laennec膜
胆囊板入路
Liver neoplasms
Hepatectomy
Extrahepatic hepatic pedicle dissection
Minimally invasive anatomic liver resection
Laennec′s capsule
Cystic plate approach
