利用“APR三角”区域联合Laennec膜的胆囊板入路在腹腔镜解剖性右叶肝段切除术中的应用

Application of gallbladder plate approach using Laennec membrane based on APR triangle region in laparoscopic anaphylactic right lobe hepatectomy

摘要:

目的 探讨利用“APR三角”区域联合Laennec膜的胆囊板入路行腹腔镜解剖性右叶肝段切除术的安全性和临床疗效。方法 收集2021年1月－2023年12月该院利用“APR三角”区域联合Laennec膜的胆囊板入路行腹腔镜解剖性右叶肝段切除术的27例患者的病例资料。分析患者手术时间、术中出血量、术后并发症和术后住院时间等情况。结果 27例患者均在腹腔镜下完成解剖性肝切除，无围手术期死亡病例。其中，Ⅴ段切除4例，Ⅵ段切除3例，Ⅴ段+Ⅷ段切除6例，Ⅴ段+Ⅵ段切除4例，Ⅵ段+Ⅶ段切除5例，Ⅴ段+Ⅵ段+Ⅶ段切除3例，Ⅴ段+Ⅵ段+Ⅷ段切除2例。根据中国肝癌分期方案（CNLC），Ⅰ_a期15例，Ⅰ_b期8例，Ⅱ_a期4例。手术时间（258.3±62.3）min，术中出血量（168.8±48.1）mL，术中未输血。术后第1天给予流质饮食，术后第2天下床活动，术后平均（4.5±0.5）d拔除腹腔引流管，术后平均住院时间（6.5±1.7）d。术后出现Clavien-Dindo Ⅰ级和Ⅱ级并发症5例（腹腔积液3例，胸腔积液1例，肺部感染1例），无胆漏和腹腔出血等并发症发生。术后病理：肝细胞癌21例，肝胆管细胞癌4例，肝转移瘤2例。对于肝恶性肿瘤患者，术后随访2个月～2年，随访期内患者均存活，未见肿瘤复发。结论 利用“APR三角”区域联合Laennec膜的胆囊板入路行腹腔镜解剖性右叶肝段切除术，是一种安全、有效的手术方法，值得临床推广应用。

Abstract:

Objective To investigate the safety and clinical efficacy of the combined gallbladder plate approach using Laennec membrane based on APR triangle in laparoscopic anaphylactic right lobe hepatectomy.Methods Clinical data of 27 patients underwent laparoscopic anaphylactic of right lobe hepatectomy based on the APR triangle combined with the gallbladder plate approach using Laennec membrane were collected from January 2021 to December 2023. The relevant data of patients were statistically analyzed, including operation time, intraoperative blood loss, postoperative complications, and postoperative hospital stay.Results All the 27 patients underwent laparoscopic anatomic hepatectomy, and no perioperative death occurred. Among them, segment Ⅴ was resected in 4 cases, segment Ⅵ in 3 cases, segment Ⅴ + Ⅷ in 6 cases, segment Ⅴ+Ⅵ in 4 cases, segment Ⅵ + Ⅶ in 5 cases, segment Ⅴ + Ⅵ + Ⅶ in 3 cases, and segment Ⅴ + Ⅵ + Ⅷ in 2 cases. All cases belonged to the China Liver Cancer (CNLC) clinical staging, stage Ⅰ_a in 15 cases, stage Ⅰ_b in 8 cases and stage Ⅱ_a in 4 cases. The operative time was (258.3 ± 62.3) min, the intraoperative blood loss was (168.8 ± 48.1) mL, and there was no transfusion. The patients were given liquid diet on the first day after surgery, and were active in bed on the second day after surgery. The mean postoperative length of hospital stay was (6.5 ± 1.7) d after removal of abdominal drainage tube. There were 5 cases of Clavien-Dindo Ⅰ and Ⅱ complications (3 cases of abdominal effusion, 1 case of pleural effusion, 1 case of pulmonary infection), and no complications such as bile leakage and abdominal hemorrhage occurred. Postoperative pathology: 21 cases of hepatocellular carcinoma, 4 cases of hepatociliary duct carcinoma, 2 cases of liver metastasis. Patients with liver malignant tumor were followed up for 2 months to 2 years, and all patients survived during the follow-up period without tumor recurrence.Conclusion The gallbladder plate approach based on APR triangle combined with Laennec membrane is a safe and effective surgical method for laparoscopic anaphylactic right lobe hepatectomy, which is worthy of clinical application.