摘要
目的 比较Laennec入路腹腔镜解剖性肝切除与传统经Glisson肝蒂解剖腹腔镜肝切除的效果。方法 选取97例肝肿瘤、肝胆管结石、肝血管瘤患者进行前瞻性研究,按照随机数字表法分为2组,分别行经Glisson肝蒂(对照组)、Laennec入路(观察组)的腹腔镜解剖性肝切除术。比较两组的手术指标、不良事件发生情况,并统计血清指标(ALT、AST、Alb)。结果 观察组手术时间(164.3±31.9)min、肝门阻断时间(51.0±6.1)min、肝周游离时间(15.5±3.7)min、肝蒂分离时间(19.5±4.8)min、肝后分离时间(5.5±1.3)min、肝实质离断时间(41.0±7.2)min、住院时间(10.3±3.1)d,均短于对照组[(196.5±34.8)min、(67.0±5.6)min、(19.0±4.3)min、(24.5±5.4)min、(7.5±2.1)min、(47.0±7.5)min、(13.0±3.4)d],术中出血量(232.4±47.5)mL少于对照组(284.6±52.3)mL,不良事件总发生率(0%)低于对照组(10.0%)、术后血清Alb水平(38.6±5.1)g/L高于对照组(34.2±3.5)g/L,术后血清ALT(276.8±13.1)U/L、AST(253.6±15.4)U/L水平均低于对照组[(315.5±14.2)U/L、(297.6±16.5)U/L](P<0.05)。结论 与传统经Glisson肝蒂解剖腹腔镜肝切除相比,Laennec入路手术时间短,更利于肝功能恢复及术后的康复。
Objective To compare the efficacy of Laennec approach laparoscopic anatomic hepatectomy with traditional Glisson pedicle anatomic laparoscopic hepatectomy.Methods 97 patients with hepatic tumor,hepatolithiasis and hepatic hemangioma were selected for prospective study.Patinets were divided into 2 groups according to random number table method,and underwent laparoscopic ananatomical hepatectomy via Glisson hepatic pedicle and Laennec approach respectively.The surgical indexes and adverse events were compared between the two groups.Serum indexes(ALT,AST,Alb)were analyzed.Results In the observation group,the operation time was(164.3±31.9)min,the hilar occlusion time was(51.0±6.1)min,the perihepatic free time was(15.5±3.7)min,the liver pedicle separation time was(19.5±4.8)min,the posthepatic separation time was(5.5±1.3)min,and the hepatic parenchyma separation time was(41.0±7.2)min and hospitalization time was(10.3±3.1)d,which were shorter than control group[(196.5±34.8)min,(67.0±5.6)min,(19.0±4.3)min,(24.5±5.4)min,(7.5±2.1)min,(47.0±7.5)min,(13.0±3,4)d].The intraoperative blood loss(232.4±47.5)mL was lower than that of the control group(284.6±52.3)mL.The overall incidence of adverse events(0%)lower than control group(10%),and the postoperative serum Alb level(38.6±5.1)g/L was higher than the control group(34.2±3.5)g/L.The levels of serum ALT(276.8±13.1)U/L and AST(253.6±15.4)U/L were lower than those of control group after operation[(315.5±14.2)U/L,(297.6±16.5)U/L](P<0.05).Conclusion Compared with traditional laparoscopic hepatectomy via Glisson pedicle dissection,Laennec approach is not only shorter in operation time,but also more beneficial to liver function and postoperative rehabilitation.
作者
王财庆
方健
谢冬冬
徐良明
余德才
WANG Cai-qing;FANG Jian;XIE Dong-dong;XU Liang-ming;YU De-cai(Department of Hepatobiliary Surgery,Gaochun People's Hospital,Nanjing 211300,China;Department of Hepatobiliary Surgery,Gulou Hospital,Nanjing 210003,China)
出处
《肝脏》
2025年第11期1568-1571,1576,共5页
Chinese Hepatology
基金
南京市卫生健康委员会(ZKX22063)。
