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  本文關(guān)鍵詞： 腹腔鏡 肝切除 臨床研究　出處：《山東大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探討腹腔鏡肝切除的技術(shù)要點,分析腹腔鏡左肝及右肝手術(shù)患者的圍手術(shù)期治療效果。方法:回顧性分析齊魯醫(yī)院2008年8月至2016年12月263例腹腔鏡肝切除患者資料,包括腹腔鏡左肝142例、右肝113例、尾狀葉8例。按病變位置不同分為腹腔鏡左肝手術(shù)組(n=142)及腹腔鏡右肝手術(shù)組(n=113),對比兩組患者一般資料、手術(shù)相關(guān)指標及術(shù)后轉(zhuǎn)氨酶變化。探討我科腹腔鏡肝切除的技術(shù)要點,包括建立氣腹、體位選擇、Trocars分布、術(shù)野暴露技巧及肝門阻斷技巧。結(jié)果:兩組患者一般資料無明顯統(tǒng)計學差異。與腹腔鏡左肝切除比較,右肝切除手術(shù)所需時間較長[(154.63±67.84)min比(131.12±59.45)min,P=0.041]、術(shù)中出血量較多[(290.69±374.28)ml 比(141.61±153.33)ml,P=0.003]、術(shù)后住院天數(shù)較多[(11.05±4.33)d 比(8.95±4.61)d,P=0.007];腹腔鏡左肝肝門阻斷率 6.3%,腹腔鏡右肝肝門阻斷率61.9%,p=0.000;兩組患者平均肝門阻斷時間沒有明顯差別,(右肝 vs 左肝 22.35±7.14min vs 18.13±6.70min,p=0.126)。腹腔鏡左肝切除基本無需肝門阻斷。腹腔鏡右肝切除時,肝門阻斷的平均時間為(24.06±7.27)min。兩組患者術(shù)后第1、3、6天ALT、AST、TBil水平均不同程度升高;術(shù)后第1天,右肝組患者ALT、AST水平高于左肝組,差異有統(tǒng)計學意義[術(shù)后第 1 天:ALT(265.83±222.18 U/L)比(133.21±96.26U/L),P=0.000;AST(265.53±288.49 U/L)比(141.84±95.64 U/L),P=0.003]。術(shù)后第3天、第6天兩組患者ALT、AST無明顯統(tǒng)計學差別(p0.05)。兩組患者術(shù)后總膽紅素水平均輕度上升,差異無統(tǒng)計學意義(P0.05)。結(jié)論:腹腔鏡右肝切除相比腹腔鏡左肝切除,手術(shù)時間長、術(shù)中出血多、術(shù)后住院時間長、肝門阻斷率更高,術(shù)后轉(zhuǎn)氨酶水平升高更明顯,提示腹腔鏡右肝切除確實比腹腔鏡左肝切除難;熟練掌握腹腔鏡技術(shù),巧妙運用手術(shù)暴露技巧及阻斷血流技巧,腹腔鏡肝大部切除、尾狀葉切除亦能安全有效實施
[Abstract]:Objective: to discuss the technical points of laparoscopic hepatectomy and to analyze the perioperative effect of laparoscopic left and right hepatectomy. Methods: from August 2008 to December 2016, 263 cases of laparoscopic hepatectomy in Qilu Hospital were retrospectively analyzed. There were 142 cases of laparoscopic left liver, 113 cases of right liver and 8 cases of caudate lobes. According to the location of the lesions, they were divided into two groups: laparoscopic left liver operation group (n = 142) and laparoscopic right liver operation group (n = 113). The general data of the two groups were compared. Objective: to discuss the technical points of laparoscopic hepatectomy, including the establishment of pneumoperitoneum and the selection of Trocars distribution. Results: there was no significant difference in general data between the two groups. The operation time of right hepatectomy was longer [154.63 鹵67.84min vs 131.12 鹵59.45min P0.041], the amount of intraoperative bleeding was more [290.69 鹵374.28ml vs 141.61 鹵153.33ml / ml compared with 141.61 鹵153.33ml / ml P0. 003], the length of postoperative hospitalization was longer [11.05 鹵4.33d vs 8.95 鹵4.61dP0.007]; There was no significant difference between the two groups (right liver vs left liver 22.35 鹵7.14 min vs 18.13 鹵6.70 min). The mean time of hepatic hilus occlusion was 24.06 鹵7.27 min. The level of alt ASTBil in the right liver group was higher than that in the left liver group on the 1st and 6th day after operation, and the level of TBil in the right liver group was higher than that in the left liver group on the first day after operation, and the level of TBil in the right liver group was higher than that in the left liver group. The difference was statistically significant (265.83 鹵222.18 U / L on the first day after operation) compared with 133.21 鹵96.26UL / L 0.000 AST / L (265.53 鹵288.49 U / L) compared with 141.84 鹵95.64 U / L P 0.003. There was no significant difference in alt between the two groups on the 3rd and 6th day after operation. Conclusion: laparoscopic right hepatectomy has longer operation time, more bleeding, longer hospitalization, higher hepatic hilus occlusion rate and higher level of transaminase than laparoscopic left hepatectomy. The results suggest that laparoscopic right hepatectomy is more difficult than laparoscopic left hepatectomy, and mastering laparoscopic technique, skillfully using surgical exposure techniques and blocking blood flow skills, laparoscopic subtotal hepatectomy and caudate lobectomy can be carried out safely and effectively.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.3

【參考文獻】

相關(guān)期刊論文 前10條

1 肖樂;李建偉;郭鵬;王小軍;別平;鄭樹國;;機器人輔助腹腔鏡肝切除術(shù)的經(jīng)驗初探[J];外科理論與實踐;2016年03期

2 葉青海;柳雙;;腹腔鏡及機器人手術(shù)在結(jié)直腸癌肝轉(zhuǎn)移治療中的合理應用及評價[J];中國實用外科雜志;2016年04期

3 張雯雯;王宏光;紀文斌;盧實春;;機器人肝切除技術(shù)的優(yōu)勢和弊端[J];肝膽外科雜志;2016年01期

4 靳斌;周兵海;杜剛;劉炎鋒;唐振宇;黃國振;韓立濤;劉澤陽;李佳;張士哲;付志浩;胡三元;;改良腹腔鏡肝右后葉血管瘤切除35例報告[J];中華肝膽外科雜志;2015年11期

5 許勇;胡明根;趙國棟;趙之明;李成剛;譚向龍;張煊;劉榮;;模式化腹腔鏡右半肝切除術(shù)[J];中華腔鏡外科雜志(電子版);2015年04期

6 李偉男;彭慈軍;舒德軍;梅永;李雄雄;謝萬桃;;肝臟缺血再灌注損傷的研究進展[J];世界華人消化雜志;2015年22期

7 鳳鳳;唐文博;劉榮;;單中心腹腔鏡解剖性肝切除學習曲線研究[J];中華腔鏡外科雜志(電子版);2015年02期

8 王雪飛;胡明根;趙國棟;許勇;許大彬;薛瑞華;劉榮;;一種腹腔鏡標準術(shù)式的探索:模式化腹腔鏡左半肝切除術(shù)[J];中華腔鏡外科雜志(電子版);2014年03期

9 李勝偉;劉超;龐志剛;何燕新;;肝門阻斷過程中捫摸對肝缺血再灌注損傷的影響及其機制研究[J];重慶醫(yī)科大學學報;2014年04期

10 朱自滿;許月芳;張杰;杜俊東;譚向龍;王大東;張文智;焦華波;;腹腔鏡左肝葉切除術(shù)的學習曲線[J];肝膽外科雜志;2013年01期

，

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