3D腹腔镜联合三维重建行肝右叶肿瘤切除术的应用研究

Application of 3D laparoscopy combined with 3D reconstruction in the hepatectomy of right lobe tumor

目的探讨3D腹腔镜联合三维重建在肝右叶肿瘤切除术中的临床应用价值。方法收集徐州市中心医院2019年1月至2021年12月行腹腔镜下肝右叶肿瘤切除术患者的临床资料进行回顾性分析,按照腹腔镜手术种类的不同分为3D腹腔镜组(22例)与2D腹腔镜组(32例)。所有患者术前已完善三维重建。收集两组患者手术时间、术中出血量、术后引流量、拔除引流管时间、术后肛门排气时间、术后并发症情况、术前及术后3 d肝功能指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转肽酶(γ-GT)]等临床资料进行比较分析。结果54例患者均成功完成手术,3D腹腔镜组手术时间[(250.5±60.4)min vs.(296.9±77.2)min]、术中出血量[(183.6±78.7)mL vs.(273.0±136.0)mL]均少于2D腹腔镜组,差异有统计学意义(P<0.05)。两组术后引流量、拔管时间、术后肛门排气时间、术后并发症发生情况,以及手术前后ALT、AST、γ-GT水平比较,差异均无统计学意义(P>0.05)。3D腹腔镜组组内分析显示,肿瘤位置是影响手术时间的关键因素,行单一肝段切除时,肝Ⅶ段手术时间[(355.0±91.9)min]较肝Ⅴ段[(207.0±49.7)min]、肝Ⅵ段[(219.2±36.7)min]明显延长(P<0.05)。结论3D腹腔镜联合三维重建在肝右叶肿瘤切除术中可减少术中出血、缩短手术时间,且不增加手术风险。

Objective To investigate the clinical value of three-dimensional(3D)laparoscopy combined with 3D reconstruction in the hepatectomy of right lobe tumor.Methods The clinical data of patients who underwent laparoscopic resection of right lobe tumor of liver from January 2019 to December 2021 in Xuzhou Central Hospital were collected and analyzed retrospectively.According to different types of laparoscopy,patients were divided into the 3D laparoscopic group(n=22)and the two-dimensional(2D)laparoscopic group(n=32).All patients underwent 3D reconstruction before surgery.Clinical data such as operation time,intraoperative blood loss,postoperative drainage volume,exhaust time,postoperative anal exhaust time,postoperative complications,preoperative and postoperative three days liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyl transpeptide(γ-GT)]were collected and compared between the two groups.Results All the 54 patients successfully completed the operation.The operation time[(250.5±60.4)min vs.(296.9±77.2)min]and intraoperative blood loss[(183.6±78.7)mL vs.(273.0±136.0)mL]in the 3D laparoscopic group were less than those in the 2D laparoscopic group,and the differences were statistically significant(P<0.05).There was no significant difference in postoperative drainage volume,extubation time,postoperative anal exhaust time,postoperative complications,and ALT,AST,γ-GT levels before and after operation between the two groups(P>0.05).The intra-group analysis of 3D laparoscopic group showed that the tumor location was the key factor affecting the operation time.When a single segment of liver was resected,the operation time of resection of segmentⅦfor liver tumors[(355.0±91.9)min]was significantly longer than that of segmentⅤ[(207.0±49.7)min]and segmentⅥ[(219.2±36.7)min](P<0.05).Conclusion 3D laparoscopy combined with 3D reconstruction can reduce intraoperative bleeding,shorten the operation time without increasing surgical risk.