下腔静脉右侧入路建立肝脏悬吊系统的腹腔镜右半肝切除术的临床研究

目的研究肝细胞癌腹腔镜右半肝切除术中从下腔静脉右侧入路建立肝脏悬吊技术可行性及安全性。方法选取2017年3月至2019年3月间120例行腹腔镜右半肝切除术(LRH)的肝癌患者进行前瞻性随机对照研究。随机分为2组,一组行传统LRH(传统组,n=60),另一组从下腔静脉右侧入路建立肝脏悬吊系统行LRH(悬吊组,n=60)。采用软件SPSS17.0进行统计学分析。围术期各项指标等计量资料以(x±s)表示,采用独立t检验;术后并发症、术后生存率计数资料以%表示,采用χ^2检验分析;以P<0.05表示差异有统计学意义。结果两组患者围术期均未发生死亡病例;悬吊组手术时间、肝门Pringle阻断时间、术中出血量、术中输血例数均明显少于传统组(P<0.05);两组中转开放、切缘大小、住院时间、术后并发症发生率和术后复发率相比差异无统计学意义(P>0.05);传统组术后6个月生存率(76.7%)低于于悬吊组(92.0%),12个月生存率(58.3%)也低于悬吊组(78.3%),差异有统计学意义(P<0.05)。结论从下腔静脉右侧入路建立肝脏悬吊系统的LRH能够充分显露肝断面,有效降低出血,缩短手术时间,安全有效。

Clinical investigation of laparoscopic right hemihepatectomy with a liver suspension system by using the right inferior vena cava approach

Objective To investigate the feasibility and safety of establishing a liver suspension system by using the right inferior vena cava approach in laparoscopic right hepatectomy for HCC.Methods From March 2017 to March 2019,120 patients with liver cancer underwent laparoscopic right hepatectomy(LRH)were enrolled into present prospective randomized controlled study.Patients were randomly divided into traditional group(n=60),and suspension group(n=60),while patients in traditional group received traditional LRH,and patients in suspension group received LRH with the establishment of a liver suspension system by using the right inferior vena cava approach.SPSS18.0 software was used for statistical analysis.The measurement data,such as relevant indicators in perioperative period,were expressed as (x±s) and were analyzed by using independent sample t test.Count data such as postoperative complications and postoperative recurrence rate were expressed as%and were analyzed by usingχ^2 test.A P value of<0.05 was considered as statistically significant difference.Results There was no perioperative death in both two groups.The operation time,hepatic portal Pringle blocking time,intraoperative blood loss and blood transfusion cases in suspension group were significantly less than those in traditional group respectively(P<0.05).There was no significant difference between the two groups in terms of conversion rate to open operation,incision margin size,hospitalization time,incidence of postoperative complications and postoperative recurrence rate(P>0.05).The 6-month survival rate of 76.7%in traditional group was lower than 92.0%in suspension group.The 12-month survival rate of 58.3%in traditional group was also lower than 78.3%in suspension group(P<0.05).Conclusion Laparoscopic right hepatectomy with a liver suspension system by using the right inferior vena cava approach could fully expose the liver cross-section,could effectively reduce bleeding,and could shorten the operation time,which is safe and effective.