腹腔镜肝切除术中两种选择性入肝血流阻断方法的比较

Comparison of two methods of selective hepatic vascular exclusion for laparoscopic hepatectomy

目的:比较腹腔镜肝切除术(LH)中两种选择性入肝血流阻断方法的临床效果。方法:回顾性分析2005年5月—2011年6月28例行LH患者的临床资料。根据不同的选择性入肝血流阻断方式将患者分为A组(14例,经Glisson鞘阻断)和B组(14例,打开Glisson鞘分离血管并阻断)。比较两组手术时间、术中出血及输血量,术后肝功能及血常规,术后住院天数、并发症及肝癌复发率、生存率。结果:手术时间、术中出血及输血量两组间无统计学差异(均P>0.05);术后各时间点的肝功能及血常规以及术后住院天数、并发症等两组间均无统计学差异(均P>0.05)。肝癌术后随访结果 1,2年复发率及2,3年生存率两组间亦无统计学差异(均P>0.05)。结论:经Glisson鞘阻断和打开Glisson鞘分离血管并阻断的两种方法在阻断入肝血流及保护剩余肝脏功能上无明显差异,方法的选择可由手术者习惯及手术方式决定。

Objective： To compare the clinical efficacies between two methods of selective hepatic vascular exclusion in laparoscopic hepatectomy（LH）. Methods： The clinical data of 28 patients undergoing LH from May 2005 to June 2011 were retrospectively analyzed.According to the procedures of selective hepatic vascular exclusion,the patients were divided into group A（exclusion through Glisson＇s capsule,n=14） and group B（exclusion through separated blood vessels after Glisson＇s capsule dissection,n=14）.The perioperative parameters（operative time,intraoperative blood loss and blood transfusion volume）,postoperative indexes（routine blood tests,liver function parameters,postoperative complications and hospital stay） and clinical outcomes（recurrence and survival rate） between the two groups were compared. Results： There were no significant differences in the operative time,bleeding,and transfusion volume between the two groups（all P0.05）.No significant differences were noted in parameters of liver function and routine blood tests on each postoperative time point,as well as in length of postoperative hospitalization and complications between the two groups（all P0.05）.The follow-up results showed that there were no significant differences in 1-and 2-year recurrent rate as well as 2-and 3-year survival rate between the two groups（all P0.05）. Conclusion： The two methods of selective vascular exclusion have no significant difference for LH,and the selection is on the surgeon＇s practice profile and surgical procedures.