腹腔镜下肝尾状叶切除术的安全性及可行性研究

Safety and feasibility study of laparoscopic hepatic resection of caudate lobe

目的 探讨腹腔镜肝尾状叶切除术的安全性及可行性。方法 回顾性分析2017年10月至2022年10月在四川大学华西医院行单纯肝尾状叶切除的34例病人围手术期资料,并根据手术方式不同分为腹腔镜尾状叶切除组(腔镜组,12例)和开腹尾状叶切除组(开放组,22例),对两组进行比较,结果中偏态分布计量资料采用M(P25,P75)表示。结果 34例病人均成功施行手术,包括12例腔镜手术和22例开腹手术。两组病人基线资料差异无统计学意义(P>0.05)。腹腔组手术时间[3.0(2.0,3.4) h]少于开放组[3.8(2.7,4.4) h],差异有统计学意义(P=0.027)。腔镜组术中肝门阻断时间[31.5(15.0,56.3) min]少于开放组[47.5(30.0,87.5) min],差异有统计学意义(P=0.043);腔镜组术中出血量明显少于开放组[125(35,200) mL比250(175,300) mL],差异有统计学意义(P=0.012)。腔镜组术后总胆红素水平明显低于开放组(P=0.013);而白蛋白水平明显高于开放组(P=0.018)。腔镜组住院时间为8.0(6.0,10.0) d,开放组住院时间为11.0(7.8,14.3) d,二者差异有统计学意义(P<0.05)。结论 相比于开腹单纯尾状叶切除术,腹腔镜单纯肝尾状叶切除是一种安全可行的手术方式,具有微创、术野清晰等优势。

Objective To evaluate the safety and feasibility of laparoscopic hepatic resection of caudate lobe.Methods From October 2017 to October 2022,a retrospective study was conducted for 34 patients undergoing simple caudate lobectomy.Based upon specific surgical approaches,they were assigned into two groups of laparoscopic caudate lobectomy(Lap,n=12)and open caudate lobectomy(open,n=22).The perioperative clinical data of two groups were compared.Results All surgical procedures were completed successfully.Baseline data of two groups were compared.No significant inter-group differences existed.Median values of operative duration[3.0(2.0,3.4)vs.3.8(2.7,4.4)h,P=0.027],occlusion time[31.5(15.0,56.3)vs.47.5(30.0,87.5)min,P=0.043]and intraoperative blood loss[125(35,200)vs.250(175,300)mL,P=0.012]were significantly less in laparoscopic group than those in open group.Total bilirubin level(P=0.013)was significantly lower in Lap group than that in open group while albumin level was significantly higher in Lap group(P=0.018).And mean length of hospital stay differed significantly between two groups[8.0(6.0,10.0)vs.11.0(7.8,14.3)day,P<0.05].Conclusion With a better intraoperative view and mini-invasiveness,laparoscopic hepatic caudate lobe resection is both safe and feasible.