腹腔镜下鞘外及鞘内解剖技术在左半肝癌患者中的应用

Application of laparoscopic extrathecal and intrathecal anatomy in patients with left liver cancer

目的研究左半肝癌患者腹腔镜下鞘外及鞘内解剖技术的应用效果。方法回顾性分析韶关市粤北人民医院肝胆外科一区2017年4月至2019年8月收治的65例左半肝癌患者的临床资料,按照血流阻断方法分作鞘外解剖组34例与鞘内解剖组31例。比较两组患者的围术期指标、肝功能指标、并发症发生情况和随访情况。结果鞘外解剖组患者的手术时间为(287.04±35.19)min,明显短于鞘内解剖组的(326.71±40.16)min,差异有统计学意义(P<0.05),但两组患者的术中出血量、肛门排气时间、住院时间、引流管留置时间比较差异均无统计学意义(P>0.05);术后第7天,两组患者的总胆红素(TBIL)、谷草转氨酶(AST)、谷丙转氨酶(ALT)水平明显低于术后第1天,白蛋白(Alb)明显高于术后第1天,差异均有统计学意义(P<0.05);术后第1天、第7天,两组患者的TBIL、ALB、AST、ALT比较差异均无统计学意义(P>0.05);鞘外解剖组与鞘内解剖组的患者的并发症总发生率为8.82%,9.68%,差异无统计学意义(P>0.05);鞘外解剖组患者的复发率和死亡率分别为11.76%、5.88%,与鞘内解剖组的9.68%、3.23%比较差异均无统计学意义(P>0.05)。结论鞘外和鞘内解剖技术均是腹腔镜左半肝癌切除术中有效、安全的肝脏血流阻断技术,但鞘外解剖技术的用时更短,临床应合理选择术式。

Objective To study the application effect of laparoscopic extrathecal and intrathecal anatomy in patients with left liver cancer.Methods The clinical data of 65 patients with left liver cancer treated in the First Department of Hepatobiliary Surgery,Yuebei People's Hospital from April 2017 to August 2019 were analyzed retrospectively.According to the blood flow blocking method,they were divided into extrathecal anatomy group(34 cases)and intrathecal anatomy group(31 cases).The perioperative indicators,liver function indicators,complications,and follow-up status were compared between the two groups.Results The operation time of patients in the extrathecal anatomy group was(287.04±35.19)min,which was significantly shorter than(326.71±40.16)min of the intrathecal anatomy group(P<0.05).There was no significant difference in intraoperative blood loss,anal exhaust time,hospitalization time,and drainage tube retention time between the two groups(P>0.05).On the 7^(th)day after operation,the levels of total bilirubin(TBIL),aspartate aminotransferase(AST),and alanine aminotransferase(ALT)in both groups were significantly lower than those on the 1st day after operation(P<0.05),and albumin(Alb)was significantly higher than that on the 1^(st) day after operation,with statistically significant difference(P<0.05).There were no significant difference in TBIL,Alb,AST,and ALT between the two groups on the 1^(st)and 7th day after operation(P>0.05).The total incidence of complications between the extrathecal anatomy group and the intrathecal anatomy group was 8.82%and 9.68%,which showed no statistically significant difference(P>0.05).The recurrence rate and mortality rate of patients in extrathecal anatomy group were 11.76% and 5.88%,as compared with 9.68% and 3.23%in the intrathecal anatomy group(P>0.05).Conclusion Extrathecal and intrathecal anatomical techniques are both effective and safe for blocking liver blood flow in laparoscopic resection of left liver cancer,but the operation time of extrathecal anatomical technique is shorter.The clinical operation method should be selected reasonably.