基于肝实质优先离断的腹腔镜右半肝切除流程优化及应用

Process optimization and application of laparoscopic right hemihepatectomy based on liver parenchyma transection-first approach

目的:探讨肝实质优先离断在腹腔镜右半肝切除术中的应用价值。方法:回顾性分析陆军军医大学第二附属医院肝胆外科2016年10月-2017年10月所完成的20例腹腔镜右半肝切除术手术患者资料,其中10例行肝实质优先离断腹腔镜右半肝切除术(观察组),即优先进行肝实质离断,而不是先行第一肝门解剖;另外10例行常规步骤先行第一肝门解剖,再进行肝实质离断(对照组)。比较两组患者的相关临床指标。结果:两组患者基本资料差异无统计学意义(均P>0.05)。两组患者均顺利完成手术。与对照组比较,观察组手术时间明显缩短[(273.0±70.4)min vs.(203.0±61.3)min,P<0.05],手术出血量明显减少[(470.0±427.0)mL vs.(270.0±149.4)mL,P<0.05],但术中输血量无统计学差异(P>0.05)。两组术后肝功能指标、术后住院时间、并发症发生率,以及术后肿瘤复发、转移发生率均无统计学差异(均P>0.05)。结论:肝实质优先离断在腹腔镜右半肝切除术中是一种安全、有效的方法。

Objective: To investigate the value of using liver parenchyma transection-first approach in laparoscopic right hemihepatectomy. Methods: The clinical data of 20 patients undergoing laparoscopic right hemihepatectomy from October 2016 to October 2017 in the Second Affiliated Hospital of Army Medical University were retrospectively analyzed. Of the patients, 10 cases underwent laparoscopic right hemihepatectomy using liver parenchyma transection-first approach(observation group), namely, liver parenchyma transection was prioritized rather than dissection of the first hepatic hilum, and the other 10 cases underwent laparoscopic right hemihepatectomy with the conventional process, namely liver parenchyma transection after dissection of the first hepatic hilum(control group). The main clinical variables were compared between the two groups. Results: There were on significant differences in the general data between the two groups(all P>0.05). Operations were successfully completed in all patients of the two groups. In observation group compared with control group, the operative time was significantly shortened [(273.0±70.4) min vs.(203.0±61.3) min, P<0.05], and the intraoperative blood loss was significantly decreased [(470.0±427.0) mL vs.(270.0±149.4) mL, P<0.05], while the amount of intraoperative blood transfusion showed no significant difference(P>0.05). There were no significant differences in postoperative liver function parameters, length of postoperative hospital stay and incidence of complications as well as the incidence of tumor recurrence and metastasis(all P>0.05).Conclusion: Liver parenchyma transection-first approach is a safe and effective procedure for laparoscopic right hemihepatectomy.