263例腹腔镜肝切除的技术要点及临床分析

发布时间：2018-03-02 05:14

本文关键词： 腹腔镜肝切除临床研究　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨腹腔镜肝切除的技术要点,分析腹腔镜左肝及右肝手术患者的围手术期治疗效果。方法:回顾性分析齐鲁医院2008年8月至2016年12月263例腹腔镜肝切除患者资料,包括腹腔镜左肝142例、右肝113例、尾状叶8例。按病变位置不同分为腹腔镜左肝手术组(n=142)及腹腔镜右肝手术组(n=113),对比两组患者一般资料、手术相关指标及术后转氨酶变化。探讨我科腹腔镜肝切除的技术要点,包括建立气腹、体位选择、Trocars分布、术野暴露技巧及肝门阻断技巧。结果:两组患者一般资料无明显统计学差异。与腹腔镜左肝切除比较,右肝切除手术所需时间较长[(154.63±67.84)min比(131.12±59.45)min,P=0.041]、术中出血量较多[(290.69±374.28)ml 比(141.61±153.33)ml,P=0.003]、术后住院天数较多[(11.05±4.33)d 比(8.95±4.61)d,P=0.007];腹腔镜左肝肝门阻断率 6.3%,腹腔镜右肝肝门阻断率61.9%,p=0.000;两组患者平均肝门阻断时间没有明显差别,(右肝 vs 左肝 22.35±7.14min vs 18.13±6.70min,p=0.126)。腹腔镜左肝切除基本无需肝门阻断。腹腔镜右肝切除时,肝门阻断的平均时间为(24.06±7.27)min。两组患者术后第1、3、6天ALT、AST、TBil水平均不同程度升高;术后第1天,右肝组患者ALT、AST水平高于左肝组,差异有统计学意义[术后第 1 天:ALT(265.83±222.18 U/L)比(133.21±96.26U/L),P=0.000;AST(265.53±288.49 U/L)比(141.84±95.64 U/L),P=0.003]。术后第3天、第6天两组患者ALT、AST无明显统计学差别(p0.05)。两组患者术后总胆红素水平均轻度上升,差异无统计学意义(P0.05)。结论:腹腔镜右肝切除相比腹腔镜左肝切除,手术时间长、术中出血多、术后住院时间长、肝门阻断率更高,术后转氨酶水平升高更明显,提示腹腔镜右肝切除确实比腹腔镜左肝切除难;熟练掌握腹腔镜技术,巧妙运用手术暴露技巧及阻断血流技巧,腹腔镜肝大部切除、尾状叶切除亦能安全有效实施
[Abstract]:Objective: to discuss the technical points of laparoscopic hepatectomy and to analyze the perioperative effect of laparoscopic left and right hepatectomy. Methods: from August 2008 to December 2016, 263 cases of laparoscopic hepatectomy in Qilu Hospital were retrospectively analyzed. There were 142 cases of laparoscopic left liver, 113 cases of right liver and 8 cases of caudate lobes. According to the location of the lesions, they were divided into two groups: laparoscopic left liver operation group (n = 142) and laparoscopic right liver operation group (n = 113). The general data of the two groups were compared. Objective: to discuss the technical points of laparoscopic hepatectomy, including the establishment of pneumoperitoneum and the selection of Trocars distribution. Results: there was no significant difference in general data between the two groups. The operation time of right hepatectomy was longer [154.63 卤67.84min vs 131.12 卤59.45min P0.041], the amount of intraoperative bleeding was more [290.69 卤374.28ml vs 141.61 卤153.33ml / ml compared with 141.61 卤153.33ml / ml P0. 003], the length of postoperative hospitalization was longer [11.05 卤4.33d vs 8.95 卤4.61dP0.007]; There was no significant difference between the two groups (right liver vs left liver 22.35 卤7.14 min vs 18.13 卤6.70 min). The mean time of hepatic hilus occlusion was 24.06 卤7.27 min. The level of alt ASTBil in the right liver group was higher than that in the left liver group on the 1st and 6th day after operation, and the level of TBil in the right liver group was higher than that in the left liver group on the first day after operation, and the level of TBil in the right liver group was higher than that in the left liver group. The difference was statistically significant (265.83 卤222.18 U / L on the first day after operation) compared with 133.21 卤96.26UL / L 0.000 AST / L (265.53 卤288.49 U / L) compared with 141.84 卤95.64 U / L P 0.003. There was no significant difference in alt between the two groups on the 3rd and 6th day after operation. Conclusion: laparoscopic right hepatectomy has longer operation time, more bleeding, longer hospitalization, higher hepatic hilus occlusion rate and higher level of transaminase than laparoscopic left hepatectomy. The results suggest that laparoscopic right hepatectomy is more difficult than laparoscopic left hepatectomy, and mastering laparoscopic technique, skillfully using surgical exposure techniques and blocking blood flow skills, laparoscopic subtotal hepatectomy and caudate lobectomy can be carried out safely and effectively.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3

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