摘要
目的比较在中央肝切除术中肝断面胶封法处理与肝断面敞开处理的临床效果,探讨肝断面胶封法处理的临床应用价值。方法回顾性分析2020年1月至2024年12月温州医科大学附属第一医院肝胆胰外科56例行中央肝切除术患者的临床资料,根据肝断面处理方式分为两组:肝断面胶封法处理组(n=15)和肝断面敞开处理组(n=41),比较两组患者的短期临床结局和相关临床指标差异。结果两组均无手术死亡病例,未发生肝衰竭等严重并发症。肝断面胶封法处理组出现胸腔积液2例,无胆漏、创面渗血、创面感染病例;肝断面敞开处理组发生胆漏1例,胸腔积液3例,创面渗血2例,无创面感染病例。两组术后并发症发生率比较,差异无统计学意义[13.33%(2/15)vs 14.63%(6/41),P=0.678]。两组手术时间、术中出血量、肝门阻断时间比较,差异均无统计学意义(P>0.05)。肝断面胶封法处理组术后第1天[(118.67±75.77)mL vs 150.00(120.00,210.00)mL,Z=-2.124,P=0.034]、第2天[(107.00±38.63)mL vs 150.00(100.00,220.00)mL,Z=-2.628,P=0.009]、第3天[(65.67±41.18)mL vs 130.00(80.00,220.00)mL,Z=-3.661,P<0.001]腹腔引流量均显著少于肝断面敞开处理组。两组术后第1、3、7天的丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)和肌酐(Cr)比较,差异均无统计学意义(P>0.05)。两组共40例患者于术后1个月左右再入院接受肝癌术后预防性经动脉化疗栓塞(TACE)治疗,影像学检查见肝实质强化均匀,保留肝脏血管系统显示清晰,门静脉系统、肝静脉系统均未见狭窄。结论肝断面胶封法处理操作简便、安全可靠,可有效减少中央肝切除术后早期腹腔积液。肝断面胶封法处理为中央肝切除术中肝断面处理提供了一种新的可选择方案。
Objective To compare the clinical effect of liver section sealing management and open liver section management in central hepatectomy,and to explore the clinical application value of liver section sealing management.Methods The clinical data of 56 patients who underwent central hepatectomy in the First Affiliated Hospital of Wenzhou Medical University from Jan.2020 to Dec.2024 were retrospectively analyzed.According to the different managements of liver section,patients were divided into the liver section sealing management group(n=15)and the open liver section management group(n=41).The short-term clinical outcomes and related clinical indicators between the two groups were compared.Results There were no surgical deaths,liver failure or other serious complications in either group.Two cases of pleural effusion were found in liver section sealing management group,with no case of bile leakage,cutting surface bleeding or cutting surface infection.One case of bile leakage,3 cases of pleural effusion and 2 cases of cutting surface bleeding were found in the open liver section management group,with no case of cutting surface infection.There was no significant difference in the incidence of complications between the two groups[13.33%(2/15)vs 14.63%(6/41),P=0.678].There was no statistically significant difference in terms of operation time,intraoperative blood loss,or hepatic hilum occlusion time between the two groups(P>0.05).In the liver section sealing management group,the intraperitoneal drainage volume on the 1^(st) day[(118.67±75.77)mL vs 150.00(120.00,210.00)mL,Z=-2.124,P=0.034],the 2^(nd)day[(107.00±38.63)mL vs 150.00(100.00,220.00)mL,Z=-2.628,P=0.009]and the 3^(rd) day[(65.67±41.18)mL vs 130.00(80.00,220.00)mL,Z=-3.661,P<0.001]postoperatively was significantly less than those in the open liver section management group.There was no significant difference in aminotransferase(ALT),total bilirubin(TBIL)and creatinine(Cr)levels on the 1^(st),3^(rd) and 7^(th) day postoperatively between the two groups(P>0.05).A total of 40 patients in the two groups were readmitted for prophylactic transcatheter arterial chemoembolization(TACE)1 month after after central hepatectomy.Imaging examination showed that the liver parenchyma was evenly enhanced,the preserved liver vascular system was clearly displayed,and no stenosis was found in the portal vein system or hepatic venous system.Conclusion Liver section sealing management in central hepatectomy is simple,safe and reliable,which can effectively reduce the early postoperative ascites,and provide a new alternative for liver section management.
作者
刘俊涛
杨寿璋
屠金夫
蔡华杰
LIU Juntao;YANG Shouzhang;TU Jinfu;CAI Huajie(Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)
出处
《肝胆胰外科杂志》
2025年第8期511-515,523,共6页
Journal of Hepatopancreatobiliary Surgery
基金
温州市科技局基础性医疗卫生科技项目(Y2020042)。
关键词
中央肝切除术
肝断面处理
胶封法
敞开法
术后并发症
central hepatectomy
liver section management
sealing management
open management
postoperative complication
