沿肝静脉主干入路行腹腔镜解剖性肝切除术治疗原发性肝癌的临床效果观察

Clinical effect observation of laparoscopic anatomical hepatectomy via main hepatic vein approach

目的研究沿肝静脉主干入路行腹腔镜解剖性肝切除术(LAH)在原发性肝癌(PHC)治疗中的应用效果。方法将2019年1月至2020年1月在我院拟行LAH治疗的PHC患者68例,采用随机数字表法分为主干组和常规组各34例,分别经肝静脉主干和传统入路完成手术,比较两组围术期指标、术后引流量、肝功能指标及并发症发生率。结果主干组手术时间和术中出血量明显低于常规组(P<0.05);两组术后第3 d引流量较第1 d均明显降低(P<0.05);两组术后第1 d和第3 d血清ALT和AST水平较术前明显升高(P<0.05),术后第3 d血清ALT和AST水平较第1 d明显降低(P<0.05);两组术后并发症发生率分别为20.59%和32.35%(P>0.05)。结论采用肝静脉主干入路实施LAH手术治疗PHC可有效缩短手术时间和减少术中出血量,有利于提升手术效果和安全性,为推广腹腔镜在肝脏疾病手术中的应用提供参考依据。

Objective To investigate the application of laparoscopic anatomical hepatectomy(LAH)via main hepatic vein approach in the treatment of primary hepatocellular carcinoma(PHC).Methods Sixty-eight patients with PHC who were scheduled to undergo LAH treatment in our hospital from January 2019 to January 2020 were divided into study or control group according to the random number table method,34 in each group.They were given surgery through main hepatic vein approach and traditional approach,respectively.The perioperative indexes,postoperative drainage volume,liver function indexes and incidence rates of complications were compared between the two groups.Results The surgical time and intraoperative blood loss in the study group were significantly lower than those in the control group(P<0.05).The drainage volume on the 3rd day after surgery was significantly lower than that on the 1st day(P<0.05).The serum ALT and AST levels on the 1st day and the 3rd day after surgery were significantly higher than those before surgery(P<0.05),and serum ALT and AST levels on the 3rd day after surgery were significantly lower than those on the 1st day(P<0.05).The incidence rates of postoperative complications in the two groups were 20.59%and 32.35%,respectively(P>0.05).Conclusion LAH surgery via main hepatic vein approach for PHC can effectively shorten the surgical time and reduce the intraoperative blood loss,and it is conducive to improving the surgical effects and safety.It can provide a reference for promoting the application of laparoscopy in liver disease surgery.