本文選題：腹腔鏡肝臟切除術(shù) + 難度評分系統(tǒng)��； 參考：《浙江大學(xué)》2017年博士論文

【摘要】：目的:應(yīng)用腹腔鏡肝臟切除術(shù)難度評分系統(tǒng)評估手術(shù)難度,對比不同難度手術(shù)之間的差異,研究腹腔鏡肝臟切除術(shù)難度評分系統(tǒng)的實(shí)用性,探討其臨床應(yīng)用價(jià)值。方法:回顧2008年1月至2016年8月本中心接受腹腔鏡肝臟切除術(shù)的428例患者,首先采用Ban腹腔鏡肝臟切除術(shù)難度評分系統(tǒng)(DSS-B)對手術(shù)進(jìn)行難度評分和分級,比較不同難度手術(shù)圍手術(shù)期資料的組間差異;再將手術(shù)分為解剖性切除術(shù)和非解剖性切除術(shù)兩類,在兩類中分別比較不同難度手術(shù)圍手術(shù)期資料的組間差異。之后采用基于切除范圍的腹腔鏡肝臟切除術(shù)難度評分系統(tǒng)(DSS-ER)評估手術(shù)難度,并按難度為手術(shù)分組,比較不同難度組之間的各圍手術(shù)期變量。最后,探究兩種腹腔鏡肝臟評分系統(tǒng)之間的關(guān)系。結(jié)果:根據(jù)DSS-B術(shù)前資料采用難度評分系統(tǒng)為手術(shù)進(jìn)行難度評分,其中低難度組手術(shù)92例,中等難度組手術(shù)214例,高難度組手術(shù)122例,低、中、高難度組在手術(shù)時(shí)間、術(shù)中出血、術(shù)中輸血率、肝門阻斷率、中轉(zhuǎn)開腹率和術(shù)后住院時(shí)間等變量具有顯著差異,總并發(fā)癥率和嚴(yán)重并發(fā)癥率無顯著差異;在非解剖性腹腔鏡肝臟切除術(shù)和解剖性肝臟切除術(shù)中重復(fù)以上組間對比,結(jié)果相似。根據(jù)DSS-ER將手術(shù)難度由低到高分為A級、B級和C級,3組各有病例232例、147例和46例,組間對比發(fā)現(xiàn)3組間的手術(shù)時(shí)間、術(shù)中出血、術(shù)中輸血率、肝門阻斷率、中轉(zhuǎn)開腹率、總并發(fā)癥率、嚴(yán)重并發(fā)癥率、術(shù)后住院時(shí)間均有顯著差異。分析A級、B級和C級手術(shù)的DSS-B評分,其中位數(shù)分別為4分,6分和11分,具有顯著差異。結(jié)論:DSS-B和DSS-ER均能對腹腔鏡肝臟切除術(shù)的難度進(jìn)行有效的評估,在臨床實(shí)踐中可以互為補(bǔ)充。腹腔鏡肝臟切除術(shù)評分系統(tǒng)對腹腔鏡肝切除術(shù)培訓(xùn)體系的建立具有重要的參考價(jià)值,可以在將來的臨床實(shí)踐中應(yīng)用和推廣。
[Abstract]:Objective: to evaluate the difficulty of laparoscopic hepatectomy by using the difficulty scoring system, compare the differences between different difficult operations, study the practicability of the difficulty scoring system of laparoscopic hepatectomy, and discuss its clinical application value. Methods: from January 2008 to August 2016, 428 patients underwent laparoscopic hepatectomy in our center. First of all, the difficulty score system (DSS-B) was used to evaluate the difficulty of laparoscopic hepatectomy. The perioperative data of different difficulty operations were compared, and the operation was divided into two groups: anatomic resection and non-anatomical resection. The perioperative data of different difficulty operations were compared in the two groups. Then the difficulty of laparoscopic hepatectomy (DSS-ER) was evaluated based on the resectable range, and the perioperative variables of different difficulty groups were compared according to the difficulty. Finally, the relationship between the two laparoscopic liver scoring systems was explored. Results: according to the preoperative data of DSS-B, the difficulty score system was used to evaluate the operation difficulty. 92 cases were in the low difficulty group, 214 cases in the middle difficulty group, 122 cases in the high difficulty group. There were significant differences in intraoperative blood transfusion rate, hepatic portal occlusion rate, conversion rate and postoperative hospitalization time, but there was no significant difference in total complication rate and severe complication rate. The results were similar between the two groups in non-anatomical laparoscopic hepatectomy and anatomic hepatectomy. According to DSS-ER, the difficulty of operation was classified from low to high to 232 cases (147 cases) and 46 cases (group C) respectively. The operative time, intraoperative bleeding, intraoperative transfusion rate, hepatic hilus occlusion rate and conversion rate to laparotomy were found by comparison among the three groups. There were significant differences in total complication rate, severe complication rate and postoperative hospitalization time. The median of DSS-B score was 4, 6 and 11, respectively. Conclusion both of them can evaluate the difficulty of laparoscopic hepatectomy and complement each other in clinical practice. The evaluation system of laparoscopic hepatectomy has important reference value for the establishment of training system of laparoscopic hepatectomy and can be applied and popularized in clinical practice in the future.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R657.3

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