一种标准化腹腔镜左半肝切除术模式探讨:“隧道法”腹腔镜解剖性左半肝切除术

Discussion on a standardized laparoscopic left hemihepatectomy model: “tunnel method” laparoscopic anatomical left hemihepatectomy

目的探讨"隧道法"腹腔镜解剖性左半肝切除术的安全性及可行性。方法回顾性分析2018年8月至2021年4月西南医科大学附属简阳市人民医院肝胆外科接受腹腔镜左半肝切除术患者的临床资料,根据不同的手术操作方式分为两组:"隧道法"腹腔镜解剖性左半肝切除术组(隧道法组)19例、经前入路腹腔镜解剖性左半肝切除术组(前入路组)20例,比较两组的手术时间、术中出血量、断肝时间、断肝出血量、术后住院时间、术后并发症等。结果隧道法组在手术时间、术中出血量、断肝时间、断肝出血量方面均低于前入路组[(185.53±59.84)min vs (232.50±62.92)min,(244.74±88.03)mL vs (327.50±154.30)mL,(15.11±5.53)min vs (41.25±21.21)min,(65.26±23.66)mL vs (156.50±69.46)mL],差异均具有统计学意义(均P<0.05)。两组在术后住院时间、术后并发症方面差异无统计学意义(均P>0.05)。结论"隧道法"腹腔镜解剖性左半肝切除术安全、可行,且手术时间短、出血少,有望成为腹腔镜左半肝切除的一种标准术式。

objective To investigate the safety and feasibility of“tunnel method”laparoscopic anatomical left hemihepatectomy.Methods The clinical data of patients who underwent laparoscopic left hemihepatectomy in Department of Hepatobiliary Surgery of Jianyang People’s Hospital Affiliated to Southwest Medical University from Aug.2018 to Apr.2021 were retrospectively analyzed.According to different operation methods,they were divided into two groups:19 cases in the“tunnel method”laparoscopic anatomical left hemihepatectomy group and 20 cases in the anterior laparoscopic anatomical left hemihepatectomy group.The operation time,intraoperative bleeding volume,liver disconnection time,liver disconnection bleeding volume,postoperative hospitalization time and postoperative complications between the two groups were statistically analyzed.Results The operation time,intraoperative bleeding volume,liver disconnection time and bleeding volume in the tunnel group were lower than those in the anterior approach group[(185.53±59.84)min vs (232.50±62.92)min,(244.74±88.03)m L vs (327.50±154.30) m L,(15.11±5.53)min vs (41.25±21.21)min,(65.26±23.66)m L vs(156.50±69.46)m L],and the difference was statistically significant (P<0.05).There was no significant difference in postoperative hospitalization time or postoperative complications between the two groups (all P>0.05).Conclusion“Tunnel method”laparoscopic anatomical left hemihepatectomy is safe and feasible,with short operation time and less bleeding,which is expected to become a standard method of laparoscopic left hemihepatectomy.