腹腔镜肝切除术中剔肝法联合滚凝法临床应用价值研究

Application and research of scrape-liver combined with roll-coagulation in laparoscopic hepatectomy

目的探讨腹腔镜肝切除术中剔肝法联合滚凝法的技术要点、有效性及可行性。方法采用倾向评分匹配及回顾性病例对照研究方法,对2015年5月至2019年12月青岛大学附属医院肝胆胰外科同一治疗组收治的296例行腹腔镜肝切除术病人的临床资料进行分析,根据肝实质离断及肝断面止血方法不同,分为电凝组(133例,采用超声刀传统钳夹电凝)与剔肝组(163例,采用剔肝法联合滚凝法),对比分析两组病人一般临床病理资料、术中及术后情况。结果倾向评分匹配后共184例病人配对成功,各92例。两组病例在手术时间、中转开腹、术中输血、术后出血发生率、术后胆瘘发生率、排气时间方面差异无统计学意义(P>0.05),而在术中出血、术后肝周积液发生率、术后住院时间方面差异有统计学意义(P<0.05)。结论剔肝法联合滚凝法为腹腔镜肝切除术提供了一种非常可靠实用的肝实质离断技术,能有效减少术中出血及术后肝周积液的发生,缩短术后住院时间。

ObjectiveTo explore the technical outline,effectivity and feasibility of scrape-liver technique combined with roll-coagulation technique in laparoscopic hepatectomy.MethodsThe propensity score matching(PSM)and retrospective case-control study were conducted.A total of 296 patients who underwent laparoscopic hepatectomy in the single attending group of the Affiliated Hospital of Qingdao University from May 2015 to December 2019 were collected.According to the different methods of liver parenchymal transection and hemostasis of liver section,they were divided into electrocoagulation group(133 cases,using ultrasonic scalpel traditional clamp electrocoagulation)and scrape-liver group(163 cases,using scrape-liver combined with roll-coagulation technique).The general clinicopathological data,intraoperative and postoperative conditions of the two groups were analyzed comparatively.ResultsAfter PSM,a total of 184 patients were successfully matched,92 cases respectively.There was no statistically significant difference between the two groups in terms of operation time,conversion to laparotomy,intraoperative blood transfusion,incidence of postoperative bleeding,incidence of postoperative biliary leakage,and exhaust time(P>0.05),while intraoperative bleeding,the incidence of postoperative perihepatic effusion and postoperative hospital stay were statistically significant(P<0.05).ConclusionScrape-liver combined with roll-coagulation is a very reliable and practical technique for liver parenchymal transection,which can effectively reduce intraoperative bleeding,reduce the incidence of postoperative perihepatic effusion,and shorten the hospital stay.