直线切割闭合器联合LigaSure在腹腔镜下半肝切除术中的疗效分析

Efficacy of linear cutter stapler combined with LigaSure in laparoscopic hemihepatectomy

目的:分析直线切割闭合器联合LigaSure在腹腔镜下半肝切除术中的应用价值及临床疗效。方法:回顾分析2014年1月至2015年12月22例行腹腔镜下半肝切除术患者(研究组)的临床资料,术中应用直线切割闭合器联合LigaSure,10例行右半肝切除,12例行左半肝切除;对照组为20例行常规开腹肝癌半肝切除术的患者,11例行左半肝切除。对比两组术中出血量、手术时间、住院时间、术后疼痛评分、住院费用及术后并发症发生率。结果:两组均顺利完成手术,无一例中转开腹。研究组术中出血量[(760.5±409.4)ml]少于对照组[(1 250.5±454.9)ml,P=0.001],手术时间[(235.4±21.4)min]短于对照组[(265.5±20.0)min,P=0.000],住院时间[(4.6±2.2)d]短于对照组[(7.2±3.0)d,P=0.003)],术后疼痛轻于对照组(P=0.031)。两组住院费用差异无统计学意义(P=0.114),术后研究组1例发生肺部感染,对照组1例发生胆漏,两组并发症发生率差异无统计学意义(P=0.919)。结论:腹腔镜半肝切除术中应用直线切割闭合器联合LigaSure具有手术时间短、术中出血量少、术后疼痛轻、康复快的优点,可成为腹腔镜下肝癌半肝切除的首选方法。

Objective： To analyze the application value and clinical efficacy of linear cutter stapler combined with LigaSure in laparoscopic hemihepatectomy. Methods： The clinical data of 42 patients who underwent laparoscopic hemihepatectomy from Jan. 2014 to Dec. 2015 were retrospectively analyzed,including 22 cases using linear cutter scalpel combined LigaSure（ research group,10 patients underwent right hemihepatectomy,12 patients left hemihepatectomy）,and 20 cases using traditional open operation（ control group,11 patients underwent left hemihepatectomy,9 patients right hemihepatectomy）. The intraoperative blood loss,operation time,hospital stay,postoperative pain,hospitalization expenses and postoperative complications of two groups were compared. Results： All patients were successfully operated without conversion to laparotomy. The research group was associated with less blood loss [（ 760. 5 ±409. 4） ml vs.（ 1 250. 5 ± 454. 9） ml,P = 0. 001 ],shorter operative time [（ 235. 4 ± 21. 4） min vs.（ 265. 5 ± 20. 0） min,P =0. 000],shorter hospital stay [（ 4. 6 ± 2. 2） d vs.（ 7. 2 ± 3. 0） d,P = 0. 003]and lower pain score（ P = 0. 031）. There was no statistical difference in hospitalization cost（ P = 0. 114） and postoperative complications（ P = 0. 919）. One case of lung infection occurred in research group and one case of biliary leakage occurred in control group. Conclusions： Laparoscopic hemihepatectomy with linear cutter stapler combined LigaSure has the advantages of shorter operative time,less intraoperative blood loss,fewer postoperative pain,faster postoperative recovery,it could be the preferred method in the laparoscopic hemihepatectomy for hepatic cancer.