摘要
目的探讨Arantius韧带肝外阻断左肝静脉在腹腔镜左肝切除术中的应用价值。方法选取2014年1月至2016年6月本院收治的56例腹腔镜左肝切除术患者为研究对象,随机分为2组,每组28例。对照组给予传统左肝静脉处理;观察组给予Arantius韧带肝外阻断左肝静脉。比较两组患者围术期各指标、术后并发症发生率及手术前后肝功能及应激反应指标水平。结果与对照组相比,观察组患者术中出血量少,恢复胃肠功能时间及住院时间均较短,差异有统计学意义(t值分别为17.905、2.017、3.908,P值分别为<0.001、0.042、0.019),两组患者手术时间和肝血流阻断时间差异无统计学意义(t值分别为0.965、0.482,P值分别为0.104、0.517)。观察组患者左肝静脉阻断前后血流动力学指标(外周循环阻力、肺循环阻力、平均动脉压)更为平稳,在不同时间点(切断前、切断后5分钟、切断后10分钟)与对照组对比,差异均有统计学意义(P均<0.05)。观察组和对照组的术后并发症发生率分别为3.57%和17.85%,差异有统计学意义(χ~2=5.973,P=0.014)。手术后两组患者肝功能及及应激指标水平均上升,观察组上升幅度显著小于对照组(P均<0.05)。结论通过Arantius韧带肝外阻断左肝静脉应用于腹腔镜左肝切除术有助于减少患者术中出血量、降低术后并发症、保护肝功能,还具有恢复快、创伤小等诸多优点,值得推广。
Objective To explore the application value of left hepatic vein occlusion through Arantius ligament in laparoscopic left liver resection. Methods Total of 56 cases underwent laparoscopic left liver resection in our hospital from January 2014 to June 2016 were randomly selected and divided into two groups, with 28 cases in each group. Patients in control group were treated with traditional left hepatic vein occlusion, while patients in observation group were treated with left hepatic vein occlusion through Arantius ligament. Various indexes in perioperative period, postoperative complications, liver function before and after operation and the level of stress reaction indexes were compared.Results Compared with control group, the bleeding amount during operation in observation group was less, time of gastrointestinal function recovery and hospital stay were shorter, the differences were statistically significant （t = 17.905, 2.017, 3.908; P 〈 0.001, 0.042, 0.019）.The operation time and hepatic blood flow blocking time had no statistically significant differences between two groups （t = 0.965, 0.482; P = 0.104, 0.517）. Hemodynamic parameters including peripheral vascular resistance, pulmonary vascular resistance and mean arterial pressure in observation group before and after left hepatic vein occlusion were more stable, there were significant differences between two groups at different time points （P 〈 0.05）. The postoperative complication rate in the observation group and control group were 3.57% and 17.85%, respectively, the difference was statistically significant （χ^2 = 5.973, P = 0.014）.After surgery, indexes of liver function and stress increased in both groups, but the increase in the observation group were significantly lower than those in control group （P 〈 0.05）. Conclusions Left hepatic vein occlusion through Arantius ligament in laparoscopic left liver resection can reduce the amount of bleeding during operation and postoperative complications, and protect liver function. It also has a quick recovery, small trauma and other advantages. It is worthy to be popularized.
出处
《中国肝脏病杂志（电子版）》
CAS
2017年第1期40-44,共5页
Chinese Journal of Liver Diseases：Electronic Version
关键词
腹腔镜左肝切除术
左肝静脉
Arantius韧带肝外阻断
并发症
Laparoscopic left liver resection
Left hepatic vein
Extrahepatic occlusion of Arantius ligament
Complication
