腹腔镜肝切除评分模型可行性分析

目的应用腹腔镜肝脏切除术难度评分模型来评估手术难度，通过对比不同难度分组间的差异来评价该评分模型的临床可行性。 方法回顾锦州医科大学附属第一医院普外科(微创)肝胆病区2016年10月至2019年10月行腹腔镜肝切除术的68例患者，收集围手术期资料，分别用Hasegawa和Ban提出的评分模型(scoring model of Hasegawa和scoring system of Ban，即SM-H与SS-B)进行分组。通过比较不同难度组间的差异来评价评分模型的实用价值。 结果按SM-H进行分组的低度困难组与中度难度组之间的术中出血量、手术时间、住院时间比较，差异有统计学意义(P<0.05)；按SS-B进行分组的低、中度困难组之间比较，差异无统计学意义(P>0.05)。 结论SM-H腹腔镜肝脏切除术难度评分模型将为肝胆外科医师在对低、中度困难病例实施腹腔镜肝脏切除术前进行难度评估起到直观的量化作用。SS-B在预估低、中难度腹腔镜肝脏切除病例的术中出血量、手术时间、住院时间方面有一定参考意义。

Practicability of surgical difficulty scoring model for laparoscopic liver resection

ObjectiveTo use the surgical difficulty scoring model for laparoscopic liver resection to evaluate the difficulty of surgery, and to analyze the practicability of scoring model by comparing the differences between each difficulty groups. MethodsThe clinical data of 68 patients were reviewed in this study, who underwent a pure laparoscopic liver resection in the department of (minimally invasive) Hepatobiliary of General Surgery, Jinzhou Medical University Affiliated First Hospital, from Oct. 2016 to Oct.2019. First, the characteristics and surgical outcomes during perioperative period were collected. Next, these cases were scored by using the scoring models, respectively presented by Hasegawa (scoring model of Hasegawa, SM-H) and Ban (scoring system of Ban, SS-B), then divided into groups of different difficulty. Finally, the practicability of the scoring model in practical application was evaluated by comparing differences among each groups on the factors of the blood loss in surgery, the length of surgical time and the length of hospital stay. ResultsThere were significant differences(P<0.05) in the blood loss, length of surgical time and length of hospital stay between the low difficulty group and medium difficulty group by adopting SM-H. And by applied the SM-B, there were no significant differences(P>0.05) could be found between the low difficulty group and medium difficulty group, in the factors of blood loss, surgical time or length of hospital stay. ConclusionsSM-H, this laparoscopic liver resection surgical difficulty scoring model could provide a very intuitive quantitative way for hepatobiliary surgeons to evaluate the difficulty of surgery before performing laparoscopic liver resection in low or medium difficulty cases. SM-B has some reference significance in estimating blood loss, surgical time or length of hospital stay in the case of low and mid-difficult laparoscopic liver removal.