W型肝脏悬吊技术在全腹腔镜下全胃切除术中的应用

The application of W-shaped liver suspension technique in totally laparoscopic total gastrectomy

目的探讨W型肝脏悬吊技术在全腹腔镜下全胃切除术中的应用。方法回顾性分析2023年1月至2024年4月复旦大学附属华山医院连续收治的64例行全腹腔镜下全胃切除术病例的临床资料,术中均采用W型肝脏悬吊技术,即使用prolene线通过缝合结合悬吊的方式在左肝下方(膈顶与肝胃韧带之间)形成一个"W形"的网状结构以阻挡肝脏,观察患者术中情况及术后恢复情况。结果术中肝外叶及肝圆韧带悬吊效果理想,术区显露效果良好。手术时间为(140.9±33.2)min,肝脏悬吊时间为(2.7±0.2)min,术中失血(34.6±14.1)ml,术后住院(7.6±3.7)d。21例术后第1天肝功能指标升高,第3天开始明显下降;其中有6例术后第5天肝功能指标仍然升高,其余58例术后第5天肝功能指标均处于正常范围。无肝脏悬吊相关并发症发生。结论W型肝脏悬吊技术安全可行,不仅可以有效悬吊肝脏及肝圆韧带,还可以牵引扩大食管裂孔,或有助于迷走神经肝支的保护、降低下纵隔的手术操作及食管空肠吻合的难度。

Objective Application of"W-shaped"liver suspension technique in totally laparoscopic gastrectomy.Methods A retrospective analysis was conducted on the clinical data of 64 patients who underwent total laparoscopic gastrectomy at Huashan Hospital,Fudan University from Jan.2023 to Apr.2024.W-shaped liver suspension technique was used in all cases.This technique involves using Prolene sutures to create a W-shaped mesh structure under the left liver(between the diaphragmatic dome and the hepatogastric ligament)to suspend the liver.Intraoperative conditions and postoperative recovery of the patients were observed.Results Intraoperatively,the suspension effect of the liver′s outer lobe and the round ligament of the liver was ideal,and the surgical field exposure was excellent.The operation time was(140.9±33.2)minutes,the liver suspension time was(2.7±0.2)minutes,intraoperative blood loss was(34.6±14.1)ml,and the postoperative hospital stay was(7.6±3.7)days.Liver function indicators were elevated in 21 patients on the first postoperative day but began to decline significantly by the third day;six of these patients still had elevated liver function indicators on the fifth postoperative day,while the remaining 58 patients had normal liver function indicators on the fifth postoperative day.No complications related to liver suspension occurred.Conclusion The W-shaped liver suspension technique is safe and feasible.It not only effectively suspends the liver and the round ligament of the liver but also helps to retract and enlarge the esophageal hiatus.This technique may contribute to the protection of the hepatic branch of the vagus nerve,reduce the difficulty of surgical operations in the lower mediastinum,and facilitate esophagojejunostomy.