摘要
目的:探讨肝脏个体化三维重建在不同手术难度的腹腔镜肝切除术中的应用价值。方法:根据Hasegawa评分将2015年6月至2023年12月行腹腔镜肝切除术的肝癌患者分为低难度组(n=71,其中三维组36例、常规组35例)、中难度组(n=54,其中三维组28例,常规组26例)、高难度组(n=37,其中三维组18例,常规组19例),三维组行术前三维重建。比较各组术中情况、预后及术后住院时间。结果:低难度组中三维组与常规组手术时间、术中出血量、术中肝门阻断时间、转氨酶(术后第1天、第3天、第5天ALT、AST)、术后住院时间、并发症差异均无统计学意义(P>0.05);中难度组中三维组手术时间、术中肝门阻断时间短于常规组,术中出血量少于常规组,转氨酶(术后第1天、第3天ALT,第1天AST)低于常规组,差异有统计学意义(P<0.05);高难度组中三维组手术时间、术中肝门阻断时间、术后住院时间短于常规组,术中出血量、转氨酶(术后第1天、第3天、第5天ALT,第1天、第3天AST)低于常规组,差异有统计学意义(P<0.05)。结论:Hasegawa评分中、高难度的肝癌患者于腹腔镜肝切除术前行三维重建作用明显,值得推荐。
Objective:To investigate the application value of individualized preoperative three-dimensional(3D)hepatic r econstruction in laparoscopic hepatectomy for liver cancer patients with different levels of surgical difficulty.Methods:A total of 162 liver cancer patients undergoing laparoscopic hepatectomy from Jun.2015 to Dec.2023 were categorized by the Hasegawa score into three groups:low-difficulty group(n=71,3D subgroup=36,conventional subgroup=35),medium-difficulty group(n=54,3D subgroup=28,conventional subgroup=26),and high-difficulty group(n=37,3D subgroup=18,conventional subgroup=19).Patients in the 3D subgroups underwent preoperative 3D reconstruction.Intraoperative parameters,postoperative outcomes,and hospital stay were compared between the 3D and conventional subgroups within each difficulty group.Results:In the low-difficulty group,there were no significant differences between the 3D and conventional subgroups regarding operative time,intraoperative blood loss,duration of hepatic inflow occlusion,intraoperative blood transfusion rate,conversion rate to open surgery,postoperative transaminase levels(ALT,AST on postoperative days 1,3,and 5),postoperative hospital stay,or complication rate(P>0.05).In the medium-difficulty group,the 3D subgroup had significantly shorter operative time and duration of hepatic inflow occlusion,less intraoperative blood loss,and lower postoperative transaminase levels(ALT on days 1 and 3,AST on day 1)compared to the conventional subgroup(P<0.05).In the high-difficulty group,the 3D subgroup demonstrated significantly shorter operative time,duration of hepatic inflow occlusion,and postoperative hospital stay,as well as less intraoperative blood loss and lower postoperative transaminase levels(ALT on days 1,3,and 5;AST on days 1 and 3)compared to the conventional subgroup(P<0.05).Conclusions:Preoperative 3D reconstruction provides significant benefits for liver cancer patients classified as medium or high difficulty according to the Hasegawa score undergoing laparoscopic hepatectomy and is highly recommended.
作者
李冬永
李建光
吴肖汶
杨涛
杞映华
LI Dongyong;LI Jianguang;WU Xiaowen(Department of General Surgery,Baoshan People's Hospital,Baoshan 678000,China)
出处
《腹腔镜外科杂志》
2025年第6期419-424,433,共7页
Journal of Laparoscopic Surgery
基金
保山市科技计划项目(2024bskjylqn007)。
关键词
肝切除术
腹腔镜检查
手术难度
三维重建
Hepatectomy
Laparoscopy
Surgical difficulty
Three-dimensional reconstruction
