改良“隧道法”优先离断出入肝血管的腹腔镜左半肝切除术

Laparoscopic left hemihepatectomy by means of modified"tunnel method"with priority hepatic vessel dissection

目的:探讨改良“隧道法”(分段建立隧道)优先离断出入肝血管的腹腔镜左半肝切除术的应用价值。方法:采用回顾性描述性研究方法,收集2018年8月至2022年11月接受腹腔镜左半肝切除术患者的临床资料。根据手术方式分为隧道组(采用“隧道法”行腹腔镜解剖性左半肝切除术,n=20)与分段组(改良“隧道法”优先离断出入肝血管的腹腔镜左半肝切除术,n=20),比较两组手术时间、术中出血量、建立隧道时间、断肝时间、断肝出血量、术后住院时间、术后并发症等。结果:分段组手术时间[(158.0±27.78)min vs.(186.5±23.40)min]、建立隧道时间[(14.65±2.2)min vs.(22.40±3.73)min]、术中出血量[(187.0±105.59)mL vs.(253.0±95.87)mL]、断肝出血量[(49.0±8.04)mL vs.(63.0±9.65)mL]少于隧道组,差异有统计学意义(P<0.05)。两组断肝时间、术后住院时间、术后并发症差异无统计学意义(P>0.05)。结论:改良“隧道法”优先离断出入肝血管的左半肝切除术是在“隧道法”腹腔镜解剖性左半肝切除术基础上优化改良的手术方式,在保证安全、可行的同时进一步缩短了手术时间,值得推广。

Objective:To investigate the application value of laparoscopic left hemihepatectomy by means of a modified"tunnel method"(segmental tunnel establishment)with priority hepatic vessel dissection.Methods:A retrospective descriptive study method was used.Clinical data of patients undergoing laparoscopic left hemihepatectomy from Aug.2018 to Nov.2022 were collected.They were d ivided into two groups according to different surgical procedures.There were 20 cases in the tunnel group(the laparoscopic left hemihepatectomy with"tunnel method")and 20 cases in the multistage group(the laparoscopic left hemihepatectomy using modified"tunnel method"with priority disconnection of hepatic vessels).The operation time,intraoperative blood loss,tunnel establishment time,liver dissection time,blood loss of liver dissection,postoperative hospital stay,postoperative complications and so on were compared b etween the two groups.Results:Compared with the tunnel group,the operation time was shorter[(158.0±27.78)min vs.(186.5±23.40)min],the tunnel establishment time was shorter[(14.65±2.2)mL vs.(22.40±3.73)mL],the intraoperative blood loss was less[(187.0±105.59)mL vs.(253.0±95.87)mL],and the blood loss when liver was dissected was less[(49.0±8.04)mL vs.(63.0±9.65)mL]in the multistage group,the differences were statistically significant(P<0.05).There were no significant differences in liver dissection time,postoperative hospital stay,and postoperative complications between the two groups(P>0.05).Conclusions:The modified"tunnel method"with priority disconnection of hepatic vessels is an optimized and improved surgical method based on the"tunnel method"for laparoscopic left hemihepatectomy.This operation method can ensure safety and feasibility,and further shorten the operation time,so it is worth popularization.