腹腔镜肝脏切除术难度评分系统的实用性研究

发布时间：2018-07-06 09:14

本文选题：腹腔镜肝脏切除术 + 难度评分系统　；参考：《浙江大学》2017年博士论文

【摘要】：目的:应用腹腔镜肝脏切除术难度评分系统评估手术难度,对比不同难度手术之间的差异,研究腹腔镜肝脏切除术难度评分系统的实用性,探讨其临床应用价值。方法:回顾2008年1月至2016年8月本中心接受腹腔镜肝脏切除术的428例患者,首先采用Ban腹腔镜肝脏切除术难度评分系统(DSS-B)对手术进行难度评分和分级,比较不同难度手术围手术期资料的组间差异;再将手术分为解剖性切除术和非解剖性切除术两类,在两类中分别比较不同难度手术围手术期资料的组间差异。之后采用基于切除范围的腹腔镜肝脏切除术难度评分系统(DSS-ER)评估手术难度,并按难度为手术分组,比较不同难度组之间的各围手术期变量。最后,探究两种腹腔镜肝脏评分系统之间的关系。结果:根据DSS-B术前资料采用难度评分系统为手术进行难度评分,其中低难度组手术92例,中等难度组手术214例,高难度组手术122例,低、中、高难度组在手术时间、术中出血、术中输血率、肝门阻断率、中转开腹率和术后住院时间等变量具有显著差异,总并发症率和严重并发症率无显著差异;在非解剖性腹腔镜肝脏切除术和解剖性肝脏切除术中重复以上组间对比,结果相似。根据DSS-ER将手术难度由低到高分为A级、B级和C级,3组各有病例232例、147例和46例,组间对比发现3组间的手术时间、术中出血、术中输血率、肝门阻断率、中转开腹率、总并发症率、严重并发症率、术后住院时间均有显著差异。分析A级、B级和C级手术的DSS-B评分,其中位数分别为4分,6分和11分,具有显著差异。结论:DSS-B和DSS-ER均能对腹腔镜肝脏切除术的难度进行有效的评估,在临床实践中可以互为补充。腹腔镜肝脏切除术评分系统对腹腔镜肝切除术培训体系的建立具有重要的参考价值,可以在将来的临床实践中应用和推广。
[Abstract]:Objective: to evaluate the difficulty of laparoscopic hepatectomy by using the difficulty scoring system, compare the differences between different difficult operations, study the practicability of the difficulty scoring system of laparoscopic hepatectomy, and discuss its clinical application value. Methods: from January 2008 to August 2016, 428 patients underwent laparoscopic hepatectomy in our center. First of all, the difficulty score system (DSS-B) was used to evaluate the difficulty of laparoscopic hepatectomy. The perioperative data of different difficulty operations were compared, and the operation was divided into two groups: anatomic resection and non-anatomical resection. The perioperative data of different difficulty operations were compared in the two groups. Then the difficulty of laparoscopic hepatectomy (DSS-ER) was evaluated based on the resectable range, and the perioperative variables of different difficulty groups were compared according to the difficulty. Finally, the relationship between the two laparoscopic liver scoring systems was explored. Results: according to the preoperative data of DSS-B, the difficulty score system was used to evaluate the operation difficulty. 92 cases were in the low difficulty group, 214 cases in the middle difficulty group, 122 cases in the high difficulty group. There were significant differences in intraoperative blood transfusion rate, hepatic portal occlusion rate, conversion rate and postoperative hospitalization time, but there was no significant difference in total complication rate and severe complication rate. The results were similar between the two groups in non-anatomical laparoscopic hepatectomy and anatomic hepatectomy. According to DSS-ER, the difficulty of operation was classified from low to high to 232 cases (147 cases) and 46 cases (group C) respectively. The operative time, intraoperative bleeding, intraoperative transfusion rate, hepatic hilus occlusion rate and conversion rate to laparotomy were found by comparison among the three groups. There were significant differences in total complication rate, severe complication rate and postoperative hospitalization time. The median of DSS-B score was 4, 6 and 11, respectively. Conclusion both of them can evaluate the difficulty of laparoscopic hepatectomy and complement each other in clinical practice. The evaluation system of laparoscopic hepatectomy has important reference value for the establishment of training system of laparoscopic hepatectomy and can be applied and popularized in clinical practice in the future.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R657.3

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