区域血流阻断技术在腹腔镜肝右后叶切除术中的应用价值
Application value of laparoscopic right-posterior lobe hepatectomy using the technique of regional blood flow occlusion
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摘要:
目的:探讨区域血流阻断技术在腹腔镜肝右后叶切除术中的应用价值。
方法:采用回顾性横断面研究方法。收集2007年5月至2017年6月浙江大学医学院附属邵逸夫医院收治的27例采用区域血流阻断行腹腔镜肝右后叶切除术患者的临床病理资料,其中肝细胞癌13例、肝内胆管结石4例、肝血管瘤4例、肝脏局灶性结节性增生4例、胆管细胞癌1例、转移性肝癌1例。行肝右后叶区域血流阻断后,行胆囊切除+肝右后叶切除术。观察指标:(1)术中及术后恢复情况。(2)随访情况。采用门诊和电话方式进行随访,了解良性肝脏疾病患者术后复发情况和恶性肝肿瘤患者术后生存情况。随访时间截至2017年8月。偏态分布的计量资料以M(范围)表示。
结果:(1)术中及术后恢复情况:27例患者均采用区域血流阻断成功完成肝右后叶切除术,其中24例行腹腔镜手术,3例因腹腔镜下暴露困难中转开腹。27例患者手术时间为205 min(125~455 min),术中出血量为400 mL(50~2 000 mL),术后胃肠功能恢复时间为1 d(1~3 d),术后腹腔引流管拔除时间为3 d(2~24 d)。全组患者术后无肝衰竭、胆汁漏及因出血再次手术患者;共4例患者发生术后并发症,其中1例切口感染患者予定期换药后好转,1例下肢深静脉血栓患者予抗凝治疗后好转,2例肺部感染患者予抗感染等对症支持治疗后好转。27例患者术后住院时间为9 d(5~26 d)。(2)随访情况: 27例患者中,26例获得术后随访,1例良性肝脏疾病患者失访。26例患者随访时间为2~121个月,中位随访时间为17个月。随访期间,11例良性肝脏疾病患者术后无复发;15例恶性肝肿瘤患者术后无瘤生存时间为13个月(5~57个月),总体生存时间为14个月(5~57个月)。
结论:采用区域血流阻断技术行腹腔镜肝右后叶切除术安全可行,术后肝衰竭发生风险低,疗效较好。Abstract:Objective:To explore the application value of laparoscopic right-posterior lobe hepatectomy using the technique of regional blood flow occlusion.
Methods:The retrospectively cross-sectional study was conducted. The clinicopathological data of 27 patients who received laparoscopic right-posterior lobe hepatectomy in the Sir Run Run Shaw Hospital of Zhejiang University from May 2007 to June 2017 were collected. The hepatocellular carcinoma, intrahepatic bile duct stone, hepatic hemangioma, focal nodular hyperplasia, cholangiocarcinoma and metastatic hepatic carcinoma were respectively detected in 13, 4, 4, 4, 1 and 1 patients. The laparoscopic right-posterior lobe hepatectomy were performed after regional blood flow occlusion. Observation indicators: (1) intra- and post-operative recovery situations; (2) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative recurrence of patients with benign liver diseases and survival of patients with malignant liver tumors up to August 2017. Measurement data with skewed distribution were described as M (range).
Results:(1) Intra- and post-operative recovery situations: 27 patients underwent successful laparoscopic right-posterior lobe hepatectomy after regional blood flow occlusion, including 24 undergoing laparoscopic surgery and 3 undergoing conversion to open surgery due to difficult exposure under laparoscopy. Operation time, volume of intraoperative blood loss, recovery time of postoperative gastrointestinal function and time of postoperative abdominal drainage-tube removal were respectively 205 minutes (range, 125-455 minutes), 400 mL (range, 50-2 000 mL), 1 day (range, 1-3 days) and 3 days (range, 2-24 days). There was no postoperative hepatic failure, bile leakage and bleeding-induced reoperation. Of 4 patients with postoperative complications, 1 with wound infection was improved by regular dressing, 1 with deep venous thrombosis of the lower extremity was improved by anticoagulant therapy and 2 with pulmonary infection were improved by anti-infective supporting treatment. The duration of postoperative hospital stay in 27 patients was 9 days (range, 5-26 days). (2) Follow-up situations: 26 of 27 patients were followed up for 2-121 months, with a median time of 17 months, and 1 patient with benign liver disease lost to follow-up. During the follow-up, 11 patients with benign liver disease had no recurrence, the tumor-free and overall survival times of 15 patients with malignant liver tumors were respectively 13 months (range, 5-57 months) and 14 months (range, 5-57 months).
Conclusion:Laparoscopic right-posterior lobe hepatectomy using the technique of regional blood flow occlusion is safe and feasible, with a lower risk of liver failure and better clinical efficacies. -
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