摘要
目的 探讨肝粘贴悬吊法、W型悬吊肝左叶、前腹壁肝脏V型悬吊法在腹腔镜胃癌根治术中应用。方法 2018年10月~2022年10月我院行腹腔镜胃癌根治术的胃癌病人79例,根据悬吊方法不同分为A组(26例)、B组(26例)和C组(27例)三组。A组采用肝粘贴悬吊法,B组采用W型悬吊肝左叶法,C组采用前腹壁肝脏V型悬吊法,三组均随访至术后6个月。比较三组手术指标、并发症发生率以及术前、术后7天的肝功能变化情况。结果 B组肝悬吊时间[(16.23±2.52)分钟]和手术时间[(318.48±30.62)分钟],大于A组的(2.64±0.61)分钟和(233.64±20.67)分钟,同时也大于C组的(12.43±1.56)分钟和(270.81±25.77)分钟,C组肝悬吊时间[(12.43±1.56)分钟]和手术时间[(270.81±25.77)分钟]大于A组的(2.64±0.61)分钟和(233.64±20.67)分钟。B组出血量[(224.51±20.27)ml]和术中输血例数(5例)、C组出血量[(223.54±21.87)ml]和术中输血例数(7例)低于A组出血量[(324.54±30.51)ml]和术中输血例数(15例),差异有统计学意义(P<0.05)。术后7天B组血清丙氨酸氨基转移酶(ALT)为(27.52±3.62) U/L,门冬氨酸氨基转移酶(AST)为(25.75±3.95) U/L,白蛋白(ALB)为(31.65±3.18) g/L,C组分别为(26.54±3.73) U/L、(26.34±3.82) U/L和(32.06±3.09) g/L,均较术前升高,且B、C组术后血清ALT、AST、ALB水平高于A组,差异有统计学意义(P<0.05);A组术后肝脏裂伤发生率(11.54%)、出血发生率(7.69%)较高,B组术中壁腹膜出血发生率(11.54%)较高,三组并发症发生率比较差异无统计学意义(P>0.05)。结论 肝粘贴悬吊法操作简单、省时,但不适用于左肝肥厚者,术后脱胶可能引起肝表面撕裂出血;W型悬吊效果良好,耗时稍长,适用于肥胖、肝左叶肥大病人;V型加纱布悬吊效果适中,耗时适中。
Objective To explore the effects of liver paste suspension,W-type suspension of left lobe of liver and V-type suspension of anterior abdominal wall of liver in laparoscopic radical gastrectomy.Methods The clinical data of 79 patients with gastric cancer who underwent laparoscopic radical gastrectomy in our hospital from October 2018 to October 2022 were retrospectively analyzed.According to the different treatment methods in the data,79 patients were divided into group A(26 cases),group B(26 cases),and group C(27 cases).In group A,the liver paste suspension method was used,and in group B,the left lobe suspension method was used,and in group C,the front abdominal wall liver V suspension method was used.All three groups were followed up to 6 months after operation.The general data,operation index,complication rate and liver function changes before and 7 days after operation were compared among three groups.Results The time of liver suspension and operation in group B[(16.23±2.52)min,(318.48±30.62)min]was longer compared with group A[(2.64±0.61)min,(233.64±20.67)min]and group C[(12.43±1.56)min,(270.81±25.77)min],and the time of liver suspension and operation in group C was longer than that in group A,and the amount of blood loss and blood transfusion in group B[(224.51±20.27)ml,5 cases]and group C[(223.54±21.87)ml,7 cases]were lower than those in group A[(324.54±30.51)ml,15 cases](P<0.05).The levels of serum glutamic-pyruvate transaminase(ALT),aspartate transaminase(AST)and Albumin(ALB)in group B[(27.52±3.62)U/L,(25.75±3.95)U/L,and(31.65±3.18)g/L]and group C[(26.54±3.73)U/L,(26.34±3.82)U/L and(32.06±3.09)g/L]were higher than those before operation 7 days after operation,and the levels of serum ALT,AST and ALB in group B and group C were higher than those in group A(P<0.05).The incidence of postoperative liver laceration and bleeding in group A(11.54%,7.69%)was higher,and the incidence of intraoperative peritoneal bleeding in group B(11.54%)was higher,but the difference was no significant among three groups(P>0.05).Conclusion The liver paste suspension method is simple and time-saving,but it is not suitable for left liver hypertrophy,and postoperative degumming may cause liver surface tear and bleeding.W-type suspension has good effect and takes a little longer and is suitable for patients with obesity and hypertrophy of left lobe of liver.The suspension effect of V-shaped gauze is moderate and the time consumption is moderate.
作者
谢华辉
沈明
张仁浩
牛天峰
罗靖
李明堃
何文涛
熊健
XIE Huahui;SHEN Ming;ZHANG Renhao;NIU Tianfeng;LUO Jing;LI Mingkun;HE Wentao;XIONG Jian(Department of General Surgery,Gezhouba Central Hospital of Chinese Medicine,Third Clinical Medical College,Three Gorges University,Hubei,Yichang,443000,China;不详)
出处
《临床外科杂志》
2024年第4期406-410,共5页
Journal of Clinical Surgery
关键词
胃癌
肝粘贴悬吊法
W型悬吊肝左叶
前腹壁肝脏V型悬吊法
腹腔镜根治术
gastric cancer
liver paste suspension method
the left lobe of liver was suspended in W shape
Type V suspension method of the anterior abdominal wall liver
laparoscopic radical surgery
