腹腔镜下“两步两钉法”在肝左外叶切除术中的临床应用

Clinical efficacy of two-step two-nail approach for left lateral laparoscopic sectionectomy during liver resection

目的探讨腹腔镜下“两步两钉法”治疗肝左外叶疾病的临床疗效,旨在加快其手术标准化流程的制定。方法分析2015年8月至2020年8月南京医科大学附属淮安第一医院肝胆外科行腹腔镜下肝左外叶切除术122例病人的临床资料,按先后顺序采用随机数字表进行随机分组,分为行“两步两钉法”的观察组59例及常规腹腔镜治疗组63例,比较两组病人围手术期的相关临床指标。结果两组病人术前基本资料差异无统计学意义,具有可比性;在术中方面观察组与常规组相比,手术时间[(108.2±23.6)min比(132.4±30.5)min]、术中出血量[(115.4±90.5)mL比(202.5±102.0)mL]、肝门阻断率(10.17%比26.98%)、中转开腹率(3.39%比14.29%)均明显减少(均P<0.05);在术后第1天、第3天两组病人在白蛋白、天冬氨酸转氨酶、丙氨酸转氨酶、C反应蛋白、白细胞计数等方面的比较差异均有统计学意义(均P<0.05),术后肛门恢复排气时间[(20.4±8.4)h比(25.7±11.7)h]、术后住院时间[(5.8±1.9)d比(6.9±2.5)d]观察组低于常规组(均P<0.05),住院总费用[(3.61±0.47)万元比(3.49±0.40)万元]、术后并发症(6.78%比7.94%)两组之间差异无统计学意义(均P>0.05)。结论腹腔镜下“两步两钉法”肝左外叶切除术简单易行、安全有效、可重复性好、学习曲线短,值得在各级医院推广。

Objective To explore the clinical efficacy of two-step two-nail for laparoscopic left lateral sectionectomy during liver resection to accelerate the formulation of standardized procedures.Methods From August 2015 to August 2020,122 patients underwent left lateral segment laparoscopic liver resection.They were randomized into two groups of observation under the"two-step two-nail approach"(n=59)and conventional laparoscopy(n=63).Perioperative clinical data were compared between two groups.Results The preoperative clinical data of two groups were comparable without statistically significant difference.While comparing observation and control groups,operative duration[(108.2±23.6)min vs.(132.4±30.5)min],intraoperative volume of blood loss[(115.4±90.5)mL vs.(202.5±102.0)mL],porta hepatis interdict rate(10.17%vs.26.98%)and conversion into laparotomy(3.39%vs.14.29%)all decreased markedly(all P<0.05).Statistically significant inter-group differences existed in albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),C-reactive protein(CRP)and leucocyte count at Day 1 and 3 post-operation(all P<0.05);postoperative anal exhaust recovery time[(20.4±8.4)hours vs.(25.7±11.7)hours]and length of postoperative hospital stay[(5.8±1.9)days vs.(6.9±2.5)days]declined sharply(all P<0.05)while total hospitalization expense[(3.61±0.47)yuan vs.(3.49±0.40)yuan]and incidence of postoperative complications(6.78%vs.7.94%)showed no statistical difference(P>0.05).Conclusion During liver resection,two-step two-nail approach for left lateral laparoscopic sectionectomy is simple,safe and effective with an excellent repeatability and a short learning curve.Worthy of wider promotions at all levels of hospitals,it is expected to become a"gold standard"in the treatment of left lateral sectionectomy during liver resection.