90°左侧卧位腹直肌旁视孔腹腔镜下非解剖性肝右后叶切除术的临床研究

Clinical study of laparoscopic nonanatomical hepatectomy in the left semiprone position with the laparoscope beside the rectus abdominis for liver tumors located in the right posterior segments

目的比较90°左侧卧位腹直肌旁视孔腹腔镜与开腹非解剖性肝右后叶切除术的疗效。方法回顾性分析2013年1月至2017年12月在右江民族医学院附属医院确诊并行肝右后叶肿瘤切除术的60例患者的临床资料。其中行90°左侧卧位腹直肌旁视孔腹腔镜非解剖性肝右后叶切除术(腹腔镜组)30例,开腹非解剖性肝右后叶切除术(开腹组)30例。比较两组患者手术前后资料,评价其疗效。结果所有患者均顺利完成非解剖性肝右后叶切除术,术后病理检查示切缘均为阴性,均无围手术期死亡。腹腔镜组在手术时间、术中出血量、术后进食时间、腹腔引流管留置时间、VAS疼痛评分、术后并发症、术后总住院时间及生活质量方面均明显优于开腹组(均P<0.05)。结论 90°左侧卧位腹直肌旁视孔腹腔镜非解剖性肝右后叶切除术安全、有效,具有手术时间短、术中出血少、术后恢复快的优点,且腹腔镜肝脏手术可显著提高肝癌患者术后生存质量。

Objective To compare the efficacy between laparoscopic nonanatomic hepatectomy in the left semiprone position with the laparoscope beside the rectus abdominis and open liver resection for liver tumors in the right posterior segments.Methods The clinical data of 60 patients with liver tumor who underwent liver resection at the Affiliated Hospital of Youjiang Medical University for Nationalities from Jan.2013 to Dec.2017 were analyzed retrospectively.Thirty patients underwent laparoscopic nonanatomic hepatectomy in the left semiprone position with the laparoscope beside the rectus abdominis（the laparoscopic group）,while the remain 30 patients underwent open liver resection（the open group）.The preoperative and postoperative data between the two groups were compared.Results All patients underwent hepatectomy successfully.Postoperative pathological examination showed that all of the patients achieved negative operation margins.There was no death occurred during the perioperative period.Compared with the open group,the laparoscopic group has less operation time,intraoperative blood loss,the time to first flatus,peritoneal drainage tube detaining time,pain score,complication indicence,postoperative hospitalization length,and higher quality of life,the differences were significant（all P〈0.05）.Conclusion Laparoscopic nonanatomic hepatectomy in the left semiprone position with the laparoscope beside the rectus abdominis is safe and effective for liver tumors located in the right posterior segments.Laparoscopic hepatectomy is more effective in terms of operation time and postoperative hospitalization time to first flatus,with fewer blood loss and complication incidence.What＇s more,the postoperative patient quality of life was dramatically improved by laparoscopic treatment.