摘要目的 比较逆行性和顺行性两种不同的方法行腹腔镜左半肝切除的安全性和疗效.方法 回顾性分析2016年1月至2018年6月宁波市医疗中心李惠利医院收治的65例行腹腔镜左半肝切除术患者临床资料,依据不同手术方式分为逆行性组(n=31)和顺行性组(n=34).比较两组患者围手术期的一般资料、手术时间、术中出血量、术后住院时间以及术后出血、腹腔脓肿和胆漏等并发症情况.结果 两组患者围手术期一般资料比较,差异无统计学意义(均P>0.05).两组患者手术时间[(121.5±22.1)min比(190.9±48.9)min]和术中出血量[(118.9±84.1)ml比(195.2±85.4)ml],逆行组均少于顺行组,差异有统计学意义(均P<0.05).两组患者术后均无出血,腹腔脓肿、胆漏等并发症以及术后住院时间[(10.0±2.8)d比(12.2±3.4)d],差异均无统计学意义(均P>0.05).结论 从第二肝门到第一肝门、入肝和出肝血流阻断的逆行性左半肝切除安全、可行,在腹腔镜左半肝切除中,逆行性方法要优于顺行性.

abstractsObjective To compare the safety and efficacy of the retrograde and the antegrade tech-niques in laparoscopic left hemihepatectomy. Methods Of the 65 patients who underwent laparoscopic left hemihepatectomy between January 2016 to June 2018 at the Ningbo Li Huili Hospital of Medical Center, retrograde left hemihepatectomy was carried out in 31 patients, and antegrade left hemihepatectomy in 34 patients. The perioperative data, duration of operation, intraoperative blood loss, postoperative complications ( including major bleeding, abdominal abscess and bile leakage ) , and post-operative hospital stay were retrospectively compared between the two groups. Results There were no significant differences in the perioperative general status between the two groups (P>0. 05). Both the duration of operation [(121. 5 ± 22. 1) min vs. (190. 9 ± 48. 9) min, P<0. 05] and the amount of blood loss [(118. 9 ± 84. 1) ml vs. (195. 2 ± 85. 4) ml, P<0. 05] were significantly less in the retrograde than the antegrade group. There were no statistical differences in the incidences of major complications such as post-hepatectomy hemorrhage, abdominal abscess, or bile leakage, and in the postoperative hospital stay [(10. 0 ± 2. 8) d vs. (12. 2 ± 3. 4) d, P > 0. 05]. Conclusions Occlusion of hepatic vascular inflow and outflow combined with retrograde left hemihepatectomy was safe and feasibly. The retrograde approach was superior to the antegrade approach in laparoscopic left hemihepatectomy.