橡皮筋弹性牵拉在腹腔镜肝右后叶肿瘤切除术中的应用体会

Application of elastic stretch of rubber band in laparoscopic resection of hepatic tumor in right posterior lobe

目的:探讨腹腔镜肝右后叶肿瘤切除术中采用橡皮筋弹性牵拉法暴露肝断面的可行性及有效性。方法:回顾分析2019年1月至2021年12月为35例患者行腹腔镜肝右后叶肿瘤切除术的临床资料。其中19例术中采用橡皮筋弹性牵拉暴露法(橡皮筋组),16例采用常规显露法(常规组)。对比分析两组手术时间、术中出血量、中转开腹率、标本切缘、术后住院时间等指标。结果:两组年龄、性别、体质指数、疾病种类、肝炎背景、15 min吲哚菁绿滞留率、Child-Pugh评分等差异无统计学意义(P>0.05)。橡皮筋组失血量[(237.0±88.4)mL vs.(377.2±181.6)mL]、手术时间[(211.3±92.3)min vs.(308.7±102.4)min]、术后住院时间[(10.3±3.3)d vs.(13.4±6.8)d]优于常规组,差异有统计学意义(P<0.05)。橡皮筋组标本手术切缘与常规组相比差异无统计学意义[(1.6±1.1)cm vs.(1.4±1.3)cm,P>0.05]。橡皮筋组中1例(5.3%)、常规组2例(12.5%)中转开腹。两组均无二次开腹手术及死亡病例。结论:腹腔镜肝右后叶肿瘤切除术中采用橡皮筋弹性牵拉法暴露肝断面是安全、有效的,可缩短手术时间与术后住院时间、减少术中出血。

Objective:To investigate the feasibility and effectiveness of exposing the liver section by elastic traction of rubber band in laparoscopic resection of hepatic tumor in right posterior lobe.Methods:The clinical data of 35 patients who underwent laparoscopic resection of right posterior lobe tumors from Jan.2019 to Dec.2021 were retrospectively analyzed.The patients were divided into rubber band group(n=19)and routine group(n=16)according to whether rubber band elastic traction exposure method was used during the operation.The operation time,intraoperative bleeding,rate of conversion to laparotomy,specimen margin and postoperative hospital stay were compared between the two groups.Results:There was no significant difference in age,sex,body mass index,disease type,hepatitis background,indocyanine green retention rate at 15 min and Child-Pugh score between the two groups(P>0.05).The blood loss in the rubber band group was less than that in the routine group[(237.0±88.4)mL vs.(377.2±181.6)mL],and the difference was statistically significant(P<0.05).The average operation time[(211.3±92.3)min vs.(308.7±102.4)min]and postoperative hospital stay[(10.3±3.3)d vs.(13.4±6.8)d]in the rubber band group were shorter than those in the routine group,and the differences were statistically significant(P<0.05).The surgical margin of the rubber band group was basically the same as that of the routine group[(1.6±1.1)cm vs.(1.4±1.3)cm],and there was no significant difference(P>0.05).One case(5.3%)in the rubber band group and two cases(12.5%)in the routine group were converted to laparotomy.There were no secondary laparotomy and no death in both groups.Conclusions:It is an effective and safe method to expose the liver section by elastic traction of rubber band in laparoscopic resection of hepatic right posterior lobe tumor.It can shorten the operation time,reduce intraoperative bleeding and postoperative hospital stay.