【摘要】 目的比较前入路与传统入路肝切除术治疗复杂肝左外叶占位性病变的效果。方法回顾性分析5年来肝左外叶切除术治疗复杂肝左外叶占位性病变58例,其中前入路组32例,传统入路组26例,比较两组在手术时间、术中出血量、输血例数、并发症发生率、住院时间及预后的差异。结果与传统入路组相比,虽然两组术后并发症发生率的比较差异无统计学意义(18.8%vs.19.2%,χ2=0.08,P>0.05),但是前入路组手术时间短[(124±13)minvs.(166±14)min,t=-7.9,P<0.01],术中出血量少[(190±45)ml vs.(789±100)ml,t=-19.7,P<0.01],输血例数少(3vs.15,χ2=-15.65,P<0.01),住院时间短[(15±2)d vs.(17±2)d,t=-1.9,P<0.05],术后1,3年的无瘤生存率和累积生存率高(P<0.05)。结论前入路法可减少手术时间、术中出血和住院时间,提高术后无瘤生存率和累积生存率,是治疗复杂肝左外叶占位性病变的首选方法,值得推广。更多还原

【Abstract】 Objective To compare anterior approach(AA)with conventional approach(CA)for hepatic left lateral lobectomy in patients with complicated liver spaceoccupying lesions. Methods A total of 58 consecutive patients with complicated liver spaceoccupying lesions undergoing hepatic left lateral lobectomy were reviewed retrospectively. Among them, 32 patients received anterior approach left lateral lobectomy(anterior approach group)while the other conventional approach(conventional approach group). The operative time, intraoperative blood loss, transfusion, incidence of complications, length of hospital stay and outcomes between the two groups were compared. Results By comparison with the conventional approach group, although the incidence of postoperative complications of these two groups were comparable(18.8% vs. 19.2%, χ2=0.08, P>0.05), the operative time in AA group was less than that in CA group[(124±13)min vs.(166±14)min, t =-7.9, P<0.01], the intraoperative bleeding in AA group was less than that in CA group[(190±45)ml vs.(789±100)ml, t =-19.7, P< 0.01], the transfusion cases in AA group was also less than that in CA group(3 vs. 15, t =-15.65, P<0.01), as well as length of hospital stay in AA was less than that in CA group[(15±2)d vs.(17±2)d, t =-1.9, P<0.05]. The 1-, 3-year disease-free survival rates and cumulative survival rates of the AA group were significantly better than those of the CA group. Conclusion Anterior approach can significantly decrease operative time, intraoperative blood loss, and length of hospital stay, as well as improved the postoperative survivals. AA is the method of choice in performing left lateral lobectomy in patients with complicated liver spaceoccupying lesions, and worth spreading.更多还原