背景与目的:严重和多发并发症是影响胰十二指肠切除术(PD)后患者生存的重要因素。既往的研究主要集中于消化道重建中吻合方式的改良,以改善术后瘘的发生,而从解剖层面去减少术后并发症的发生和改善患者预后研究较少。本文总结笔者团队...背景与目的:严重和多发并发症是影响胰十二指肠切除术(PD)后患者生存的重要因素。既往的研究主要集中于消化道重建中吻合方式的改良,以改善术后瘘的发生,而从解剖层面去减少术后并发症的发生和改善患者预后研究较少。本文总结笔者团队在PD术中应用刮吸解剖法的经验,并分析其安全性和临床疗效。方法:回顾性收集2021年1月—2023年6月内蒙古医科大学附属医院肝胆外科收治的择期行PD患者的临床资料。将术中采用刮吸解剖法的患者作为观察组,术中采用传统解剖法的患者作为对照组。观察组患者术中使用彭氏多功能手术解剖器(PMOD)进行操作,对照组患者术中使用普通电刀和超声刀进行操作。比较两组患者的相关临床指标,并分析患者术后生存的影响因素。结果:共纳入169例患者,其中观察组59例,对照组110例。两组患者的一般资料差异无统计学意义(均P>0.05)。观察组术中的神经浸润情况多于对照组(64.41%vs.39.09%,P=0.002),但观察组的手术时间明显少于对照组(236.0 min vs.330.0 min,P<0.01),两组在淋巴结转移、出血量、血管浸润情况方面差异无统计学意义(均P>0.05)。观察组术后胰瘘的发生率明显低于对照组(16.9%vs.40.0%,P=0.002),两组患者的1个月内再手术率、术后住院时间、胆汁漏、出血、感染、胃排空延迟、生存情况方面差异无统计学意义(均P>0.05)。多因素Logistic回归分析结果显示,吸烟、肿瘤的神经浸润、术后胃排空延迟是影响生存的独立危险因素(均P<0.05)。结论:PMOD刮吸解剖法应用于PD是安全可行的。较传统解剖方法具有操作简单、创伤小,手术时间短、术后的优点。可间接减少术后相关并发症的发生情况。临床疗效可靠,可在临床中进行推广应用。展开更多
Background Laparoscopic surgery is advantageous for minimal invasiveness and rapid postoperative recovery. Since the use of laparoscopic hepatectomy in liver resection in the 1990s, it has been performed in a few inst...Background Laparoscopic surgery is advantageous for minimal invasiveness and rapid postoperative recovery. Since the use of laparoscopic hepatectomy in liver resection in the 1990s, it has been performed in a few institutions worldwide, Lack of efficient and safe techniques for liver transaction is the major obstacle preventing from its further development, We developed a new technique for laparoscopic hepatectomy by curettage and aspiration in 1998. In this paper we analyze the clinical outcomes of this technique after 7 years of practice.Methods Altogether 59 consecutive patients underwent laparoscopic hepatectomy by curettage and aspiration from August 1998 to January 2005 at our institution. These patients included 33 males and 26 females, with a mean age of 47 years. For liver transecsion laparoscopic Peng＇s multifunctional operative dissector （LPMOD） was used. Lesions included malignant liver tumors in 19 patients, benign liver tumors in 17, intrahepatic calculus in 18, and other liver lesions in 5. Procedures included local resections in 30 patients, left lateral segmentectomy in 28, and right hemihepatectomy in 1.Results Laparoscopic operation was completed in 57 patients. Two patients （3.4%） had the operation converted to laparotomy. The mean operating time was 143 minutes and the mean intraoperative blood loss was 456 ml. The mean length of postoperative hospital stay was 7 days. Complications occurred in 2 patients （3.4%）, and there was no pedoperative death.Conclusion Laparoscopic hepatectomy by curettage and aspiration is efficient and safe for liver resection.展开更多
文摘背景与目的:严重和多发并发症是影响胰十二指肠切除术(PD)后患者生存的重要因素。既往的研究主要集中于消化道重建中吻合方式的改良,以改善术后瘘的发生,而从解剖层面去减少术后并发症的发生和改善患者预后研究较少。本文总结笔者团队在PD术中应用刮吸解剖法的经验,并分析其安全性和临床疗效。方法:回顾性收集2021年1月—2023年6月内蒙古医科大学附属医院肝胆外科收治的择期行PD患者的临床资料。将术中采用刮吸解剖法的患者作为观察组,术中采用传统解剖法的患者作为对照组。观察组患者术中使用彭氏多功能手术解剖器(PMOD)进行操作,对照组患者术中使用普通电刀和超声刀进行操作。比较两组患者的相关临床指标,并分析患者术后生存的影响因素。结果:共纳入169例患者,其中观察组59例,对照组110例。两组患者的一般资料差异无统计学意义(均P>0.05)。观察组术中的神经浸润情况多于对照组(64.41%vs.39.09%,P=0.002),但观察组的手术时间明显少于对照组(236.0 min vs.330.0 min,P<0.01),两组在淋巴结转移、出血量、血管浸润情况方面差异无统计学意义(均P>0.05)。观察组术后胰瘘的发生率明显低于对照组(16.9%vs.40.0%,P=0.002),两组患者的1个月内再手术率、术后住院时间、胆汁漏、出血、感染、胃排空延迟、生存情况方面差异无统计学意义(均P>0.05)。多因素Logistic回归分析结果显示,吸烟、肿瘤的神经浸润、术后胃排空延迟是影响生存的独立危险因素(均P<0.05)。结论:PMOD刮吸解剖法应用于PD是安全可行的。较传统解剖方法具有操作简单、创伤小,手术时间短、术后的优点。可间接减少术后相关并发症的发生情况。临床疗效可靠,可在临床中进行推广应用。
基金the Foundation of Science and Technology Bureau of Zhejiang Province(No.2003C33055)
文摘Background Laparoscopic surgery is advantageous for minimal invasiveness and rapid postoperative recovery. Since the use of laparoscopic hepatectomy in liver resection in the 1990s, it has been performed in a few institutions worldwide, Lack of efficient and safe techniques for liver transaction is the major obstacle preventing from its further development, We developed a new technique for laparoscopic hepatectomy by curettage and aspiration in 1998. In this paper we analyze the clinical outcomes of this technique after 7 years of practice.Methods Altogether 59 consecutive patients underwent laparoscopic hepatectomy by curettage and aspiration from August 1998 to January 2005 at our institution. These patients included 33 males and 26 females, with a mean age of 47 years. For liver transecsion laparoscopic Peng＇s multifunctional operative dissector （LPMOD） was used. Lesions included malignant liver tumors in 19 patients, benign liver tumors in 17, intrahepatic calculus in 18, and other liver lesions in 5. Procedures included local resections in 30 patients, left lateral segmentectomy in 28, and right hemihepatectomy in 1.Results Laparoscopic operation was completed in 57 patients. Two patients （3.4%） had the operation converted to laparotomy. The mean operating time was 143 minutes and the mean intraoperative blood loss was 456 ml. The mean length of postoperative hospital stay was 7 days. Complications occurred in 2 patients （3.4%）, and there was no pedoperative death.Conclusion Laparoscopic hepatectomy by curettage and aspiration is efficient and safe for liver resection.
