临床研究(Clinical Research)

模式化与传统腹腔镜肝左外叶切除术的临床对比研究

Published at: 2017年第26卷第1期

张翼 1 , 罗洪亮 1 , 吴华俊 2 , 彭浪 2 , 朱培谦 1 , 梅婷 3
1 南昌大学第二附属医院胃肠外科,江西 南昌 330006
2 南昌大学第二附属医院肝胆外科,江西 南昌 330006
3 南昌大学第二附属医院消化内科,江西 南昌 330006
通讯作者 培谦 朱 Email: zhupeiqian@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.01.013
基金:

摘要

目的:探讨模式化腹腔镜下肝左外叶切除术治疗肝左外叶疾病的临床效果。方法:回顾性分析南昌大学第二附属医院2009年1月—2016年6月139例肝左外叶疾病(肝癌、血管瘤、局灶性结节增生、肝内胆管结石)行腹腔镜肝左外叶切除术患者的临床资料,其中63例腹腔镜下肝左外叶切除术采用一系列有序的、可靠的步骤进行,且术中无需精细分离肝内管道(模式化组),76例腹腔镜下肝左外叶切除术采用传统方法进行(传统组)。比较两组相关临床指标。结果:模式化组均完成腹腔镜下肝左外叶切除,传统组5例因大量出血中转开腹。与传统组比较,模式化组手术时间(80.4 min vs. 126.6 min)、术中出血量(70.6 mL vs. 150.8 mL)、术后住院时间(7.1 d vs. 10.4 d)均明显减少(均P<0.05);住院总费用(3.56万元vs. 3.65万元)、术后并发症发生率(7.9% vs. 14.5%)、肝癌患者术后1年内复发率(11.1% vs. 14.7%)差异均无统计学意义(均P>0.05)。结论:模式化腹腔镜下肝左外叶切除术疗效确切,且手术时间短、术中出血少、住院时间短,以及操作简单、易行,适合推广应用。


Stylized versus traditional laparoscopic left lateral hepatic lobectomy: a clinical comparative study

Abstract

Objective: To investigate the clinical efficacy of stylized laparoscopic left lateral hepatic lobectomy in treatment of lesions in left lateral lobe of the liver. Methods: The clinical data of 139 patients with lesions in left lateral hepatic lobe (liver cancer, hemangioma, focal nodular hyperplasia, and intrahepatic stones) undergoing laparoscopic left lateral hepatic lobectomy from January 2009 to June 2016 in the Second Affiliated Hospital of Nanchang University were retrospectively analyzed. Of the patients, laparoscopic left lateral hepatic lobectomy in 63 cases was performed with a series of sequential and reliable procedure steps, with no requirements for meticulous dissection of the intrahepatic ducts (stylized group) and in 76 cases was performed with traditional procedures (traditional group). The main clinical variables between the two groups of patients were compared. Results: Laparoscopic left lateral hepatic lobectomy was completed in all patients in stylized group, while 5 cases in traditional group were converted to open surgery due to massive hemorrhage. In stylized group compared with traditional group, the operative time (80.4 min vs. 126.6 min), intraoperative blood loss (70.6 mL vs. 150.8 mL) and length of postoperative hospital stay (7.1 d vs. 10.4 d) were all significantly reduced (all P<0.05), while, the total hospitalization expense (35 600 yuan vs. 36 500 yuan), incidence of postoperative complications (7.9% vs. 14.5%) and postoperative 1-year recurrence rates of the liver cancer patients (11.1% vs. 14.7%) showed no statistical difference (P>0.05). Conclusion: Stylized laparoscopic left lateral hepatic lobectomy has demonstrable efficacy and the advantages of short operative time, less intraoperative blood loss and short length of hospital stay, moreover, it is simple and practicable. Thus, it is recommended to be generalized and broadly used.


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引用

引用本文: 翼 张, 洪亮 罗, 华俊 吴, 浪 彭, 培谦 朱, 婷 梅. 模式化与传统腹腔镜肝左外叶切除术的临床对比研究 [J]. 中国普通外科杂志, 2017, 26(1): 77-82.
Cite this article as: ZHANG Yi, LUO Hongliang, WU Huajun, PENG Lang, ZHU Peiqian, MEI Ting . Stylized versus traditional laparoscopic left lateral hepatic lobectomy: a clinical comparative study [J]. Chin J Gen Surg, 2017, 26(1): 77-82.