自制新型腹腔镜肝门阻断设备在腹腔镜肝细胞肝癌手术中的应用

摘要

目的:自制新型腹腔镜肝门阻断设备,并探讨其应用于肝细胞肝癌(hepatocellular carcinoma,HCC)手术中的有效性及安全性,为其临床应用奠定基础.方法:采用手术室常用气管导管(7.5 mm)及输液用普通一次性输液器制作新型腹腔镜用肝门阻断设备.选择2015年3月至2016年11月我院收治的接受腹腔镜下肿瘤部分切除术的合并肝硬化的HCC患者(n=20)作为研究对象.按肿瘤部位、大小、切除范围进行匹配,患者被分为肝门阻断组和肝门非阻断组(n=10).肝门阻断组在术中采用上述自制设备进行入肝血流阻断,术中采用腔镜超声评估肝门阻断后血流阻断效果;肝门非阻断组采用同样术式,术中不阻断肝门.比较两组患者手术时间、术中出血量、术中输血量、术后并发症等指标.结果:术中超声显示自制新型腹腔镜肝门阻断设备能够有效阻断入肝血流.肝门阻断组患者手术时间明显短于肝门非阻断组[(102.0±32.5)minvs(136.5±45.8)min],差异有统计学意义(P=0.005);肝门阻断组患者术中出血量明显少于肝门非阻断组[(80.0±69.4)mLvs(170.0±163.4)mL],差异有统计学意义(P=0.011).两组患者术后均无手术相关并发症.结论:自制新型腹腔镜用肝门阻断设备制作简单方便,适用于各级医院;将其应用于腹腔镜肝肿瘤切除安全、有效,可显著减少术中出血、缩短手术时间,值得临床推广.%Objective:To examine the clinical application effect evaluation of a novel approach of laparoscopic hepatic inflow occlusion device.Methods:A self-designed device of hepatic inflow occlusion was made using tracheal catheter (7 .5 mm) and infusion set.From March 2015 to November 2016,20 HCC patients with cirrhosis were enrolled and divided into two groups according to tumor size and extent of resection:occlusion group (n= 10)received laparoscopic liver resection using the hepatic inflow occlusion,while non-occlusion group (n= 10)without.The efficacy of the occlusion apparatus was examined using laparoscopic ultrasound device.The operation time,intraoperative blood loss,intraoperative transfusion,and the postoperative complications were compared.Results:The novel approach can effectively occluded the hepatic inflow.The average operation time were (102.0±32.5)min in occlusion group and (136.5±45.8)min in non-occlusion group (P=0.005),respectively.Mean intraoperative blood loss was (80.0 ±69.4)mL in occlusion group and (170.0±163.4)mL in non-occlusion group (P= 0.011 ).One patient in non-occlusion group received transfusion (RBC,2 U).No postoperative complication was occurred in two groups.Conclusions:The novel approach of hepatic inflow occlusion is effective,safe,simple and easy for laparoscopic liver resection.It can significantly reduce length of operation and intraoperative blood loss.It can facilitate laparoscopic liver resection and is worthy of wide application.