体内W型悬吊肝左叶在腹腔镜胃手术中的应用价值

目的探讨体内W型悬吊肝左叶在腹腔镜胃手术中的应用价值。 方法回顾性分析2021年1月至2021年9月行腹腔镜胃相关手术的68例患者的病例资料及手术录像，观察悬吊所用时间及有无相关肝脏副损伤情况（如肝脏撕裂、出血、肝包膜血肿、术后肝功能异常、胆瘘）。 结果68例腹腔镜胃相关手术患者中行腹腔镜全胃切除术17例，腹腔镜下近端胃切除术7例，腹腔镜远端胃切除术25例，腹腔镜胃部分切除术19例。患者平均年龄63.3岁（30~86岁），平均体重指数24.8 kg/m²（18.6~41.7 kg/m²）。所有手术患者均顺利完成体内肝左叶W型悬吊，用时仅（3.0±1.3）min，术中没有借助特殊器械。通过手术录像观察发现有8例出现壁腹膜穿刺点出血，经电勾完成止血；所有手术患者均未发现有肝脏副损伤发生。 结论在腹腔镜胃相关手术中采用体内W型悬吊肝左叶，是一种操作简单、安全、有效的肝悬吊法。

Application values of W-type left liver lobe hanging maneuver in laparoscopic gastric surgery

ObjectiveTo investigate the application value of the left lobe of the liver with W-type suspension in vivo in laparoscopic gastric surgery. MethodsThe clinical data and surgical videos of 68 patients who underwent laparoscopic gastric surgery from January 2021 to September 2021 were retrospectively analyzed to observe the duration of suspension and the presence of related liver accessory injury（such as liver tear，bleeding，hepatic capsular hematoma，postoperative abnormal liver function and bile leakage）. ResultsAmong 68 patients who underwent the laparoscopic gastric surgery，17 patients underwent laparoscopic total gastrectomy，7 patients with laparoscopic proximal gastrectomy，25 patients with laparoscopic distal gastrectomy，and 19 patients with laparoscopic partial gastrectomy. The mean age of the patients was 63.3 years（30 to 86 years）and the mean body mass index was 24.8 kg/m²（18.6~41.7 kg/m²）. All patients successfully completed the W-type left liver lobe hanging maneuver using only（3.0±1.3）minutes and no special instruments during the operation. 8 patients of parietal peritoneal puncture site bleeding were found by surgical video. The hemostasis was completed by electrical hook. No liver injuries were found in all patients. ConclusionIt is a simple，safe and effective method to use the left lobe of liver suspension in laparoscopic gastric surgery.