【摘要】 目的探讨自制改良式肝蒂阻断带在腹腔镜特殊部位肝切除术中的应用价值。方法本前瞻性研究对象为2014年7月至2015年7月在南昌大学第二附属医院行腹腔镜特殊部位肝切除术的45例患者。所有患者均签署知情同意书,符合医院伦理学规定。其中男17例,女28例;年龄28~71岁,中位年龄50岁。手术方式:肝Ⅳb段切除5例,Ⅴ段切除8例,Ⅶ段切除10例,Ⅷ段切除9例,Ⅵ+Ⅶ段切除8例,Ⅴ+Ⅶ段切除5例。根据随机数字表法将患者分为自制改良式肝蒂阻断带阻断入肝血流组(改良组,18例)和传统手术组(传统组,27例)。传统组未阻断或采用Pringle法阻断。两组患者手术时间、术中出血量、术后住院时间比较采用t检验。结果两组患者均顺利完成手术。改良组无中转开腹,传统组中转开腹率为22%(6/27)。改良组手术时间、术中出血量、术后住院时间分别为(226±95)min、(421±90)ml、(10±4)d,传统组相应为(286±95)min、(501±91)ml、(14±4)d,差异有统计学意义(t=-2.104,-2.899,-2.913;P<0.05)。结论在腹腔镜特殊部位肝切除术中应用自制改良式肝蒂阻断带安全、可行,能够便捷、有效控制入肝血流。更多还原

【Abstract】 Objective To investigate the application value of selfmade modified hepatic pedicle occluding band in laparoscopic special section hepatectomy.Methods Forty-five patients who underwent laparoscopic special section hepatectomy in the Second Affiliated Hospital of Nanchang University between July 2014 and July 2015 were enrolled in this prospective study.The informed consents of all patients were obtained and the local ethical committee approval was received.Among the patients,17 were males and 28 were females with the age ranging from 28 to 71 years old and the median of 50 years old.Five cases underwent resection of segment Ⅳb,8 of segment Ⅴ,10 of segment Ⅶ,9 of segment Ⅷ,8 of segment Ⅵ+Ⅶ,and 5 of segment Ⅴ+Ⅶ.According to the random number table method,the patients were divided into the group of hepatic inflow occlusion with the selfmade modified hepatic pedicle occluding band(the modified group,n=18) and the traditional surgery group(the traditional group,n=27).Hepatic inflow was not occluded or was occluded by Pringle maneuver in the traditional group.The length of operation,intraoperative blood loss and postoperative length of stay in two groups were compared using t test.Results The patients in bothgroups completed the surgery successfully.No conversion to laparotomy was observed in the modified group,while the rate of conversion to laparotomy in the traditional group was 22%(6/27).The length of operation,intraoperative blood loss and postoperative length of stay in the modified group were respectively(226±95) min,(421±90) ml and(10±4) d,while those in the traditional group were respectively(286±95) min,(501±91) ml and(14±4) d,and significant differences were observed(t=-2.104,-2.899,-2.913;P<0.05).Conclusions The application of selfmade modified hepatic pedicle occluding band in laparoscopic special section hepatectomy is safe and feasible.And it can conveniently and effectively control the hepatic inflow.更多还原