Clinical effect of anterior approach laparoscopic right hemihepatectomy with two gun vascularizer

doi:10.3877/cma.j.issn.1674-3946.2022.06.013

Abstract

Abstract:

Objective

To investigate the clinical effect of anterior approach laparoscopic right hemihepatectomy（LRH）with two gun technique.

Methods

The clinical data of 62 patients who underwent anterior LRH approach from January 2019 to June 2021 were retrospectively analyzed. According to the different surgical methods，they were divided into the traditional group（n=34，using the traditional method for anterior LRH）and the two-shot group（n=28，using the vascular cutting and closure device for two-shot LRH）. SPSS 22.0 software was used to analyze the data. Perioperative indicators and other measurement data were represented by（

x ˉ

±s）. Repeated measurement data were analyzed by repeated measurement analysis of variance，and the rest were analyzed by independent sample t test. Postoperative complications and other counting data were analyzed by χ² test. P<0.05 was considered statistically significant.

Results

The operation time，liver rupture time，intraoperative blood loss，intraoperative blood transfusion and drainage tube indwelling time in the two-gun group were significantly better than those in the traditional group（P<0.05）. There was no interaction between time and method on the levels of ALB，TBil，AST and ALT（P>0.05），while the main effect of time and method on the levels of ALB，TBil，AST and ALT was significant（P<0.05）. There was no significant difference in postoperative complications between the two groups（P>0.05）.

Conclusion

The use of vascular cutting and closing device two-gun method in the anterior approach of LRH not only shortens the operation time，reduces the intraoperative injury，but also facilitates the recovery of postoperative liver function，and does not increase the risk of postoperative complications.

Key words: Hepatectomy, Laparoscopes, Anterior approach, Vascular cutting closure device, Two-gun method

Shujun Lin, Bo Zhong, Fuyu Wang, Yongbin Zheng, Sicong Chen, Shidong Huang, Xinsheng Cheng, Dingding Miao, Jinting Gao. Clinical effect of anterior approach laparoscopic right hemihepatectomy with two gun vascularizer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(06): 631-634.

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References 15

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组别	例	性别	年龄 (岁)	BMI (kg/m²)
组别	例	男/女	年龄 (岁)	BMI (kg/m²)
传统组	34	21/13	54.1±9.2	22.4±3.3
两枪组	28	18/10	55.6±8.6	22.8±3.0
t/χ²		0.042	0.735	0.499
P		0.838	0.233	0.310
组别	例	肿瘤直径 (cm)	Child-Pugh分级		病理类型
组别	例	肿瘤直径 (cm)	A/B		a/b/c
传统组	34	12.1±4.4	28/6		17/12/5
两枪组	28	11.8±4.7	22/6		15/10/3
t/χ²		0.257	0.141		0.228
P		0.399	0.708		0.892

组别	例	性别	年龄 (岁)	BMI (kg/m²)
组别	例	男/女	年龄 (岁)	BMI (kg/m²)
传统组	34	21/13	54.1±9.2	22.4±3.3
两枪组	28	18/10	55.6±8.6	22.8±3.0
t/χ²		0.042	0.735	0.499
P		0.838	0.233	0.310
组别	例	肿瘤直径 (cm)	Child-Pugh分级		病理类型
组别	例	肿瘤直径 (cm)	A/B		a/b/c
传统组	34	12.1±4.4	28/6		17/12/5
两枪组	28	11.8±4.7	22/6		15/10/3
t/χ²		0.257	0.141		0.228
P		0.399	0.708		0.892

组别	例	手术时间 (min)		断肝时间 (min)	术中出血量 (ml)
传统组	34	314.1±68.3		76.2±16.6	705.4±105.8
两枪组	28	245.6±56.2		38.5±10.3	412.3±86.5
t/χ²		4.332		10.932	12.001
P		0.000		0.000	0.000
组别	例	术中输血情况		引流管留置时间(d)	术后住院时间 (d)
组别	例	是	否	引流管留置时间(d)	术后住院时间 (d)
传统组	34	9	25	7.2±1.5	11.3±3.5
两枪组	28	1	27	6.4±1.3	10.5±3.3
t/χ²		4.380		2.249	0.924
P		0.036		0.014	0.180

组别	例	手术时间 (min)		断肝时间 (min)	术中出血量 (ml)
传统组	34	314.1±68.3		76.2±16.6	705.4±105.8
两枪组	28	245.6±56.2		38.5±10.3	412.3±86.5
t/χ²		4.332		10.932	12.001
P		0.000		0.000	0.000
组别	例	术中输血情况		引流管留置时间(d)	术后住院时间 (d)
组别	例	是	否	引流管留置时间(d)	术后住院时间 (d)
传统组	34	9	25	7.2±1.5	11.3±3.5
两枪组	28	1	27	6.4±1.3	10.5±3.3
t/χ²		4.380		2.249	0.924
P		0.036		0.014	0.180

组别	例	时间	ALB(g/L)	TBIL(μmol/L)
传统组	34	T0	44.1±3.4	18.1±5.4
		T1	35.8±2.6^a	36.0±7.3^a
		T7	37.8±1.7	25.5±5.2
两枪组	28	T0	43.5±3.6	19.0±4.8
		T1	37.2±2.4^ab	32.3±7.1^ab
		T7	39.5±1.3^b	21.2±4.4^b
F			F₁=4.201，F₂=3.513，F₃=2.016	F₁=4.643，F₂=3.701，F₃=0.958
P			P₁=0.030，P₂=0.040，P₃=0.327	P₁=0.023，P₂=0.036，P₃=0.657
组别	例	时间	AST(U/L)	ALT(U/L)
传统组	34	T0	29.6±7.8	27.1±6.8
		T1	352.2±104.1^a	378.5±117.9^a
		T7	40.5±8.6	68.4±18.3
两枪组	28	T0	30.2±7.2	26.8±6.4
		T1	285.6±87.7^ab	311.6±95.3^ab
		T7	36.2±8.1^b	46.7±13.9^b
F			F₁=5.784，F₂=4.135，F₃=0.841	F₁=5.615，F₂=4.924，F₃=1.432
P			P₁=0.018，P₂=0.033，P₃=0.814	P₁=0.019，P₂=0.021，P₃=0.279

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