自制降落伞式肝左叶悬吊装置在腹腔镜胃癌根治术中的应用

Application of a self-made parachute-type suspension device for left lobe of liver in laparoscopic radical gastrectomy for gastric cancer

摘要

目的：探讨自制降落伞式肝左叶悬吊装置在腹腔镜胃癌根治术中的应用价值。方法：回顾性分析2020年6月—2025年6月在宜昌市中心人民医院胃肠外科接受腹腔镜胃癌根治术的50例患者的临床资料，根据术中是否使用自制降落伞式肝左叶悬吊装置，将患者分为研究组（n=24）和对照组（n=26）。研究组采用自制降落伞式肝左叶悬吊装置进行悬吊，对照组采用2-0 prolene线进行W型肝左叶悬吊。对比分析两组手术总时间、肝悬吊时间、术中出血量、淋巴结清扫数目、悬吊相关副损伤、术后肝功能变化及术后胃肠功能恢复情况等指标。结果：两种肝脏悬吊方式均能获得满意的手术视野，两组手术总时间、术中出血量、淋巴结清扫数目差异均无统计学意义（P>0.05）。研究组肝脏悬吊时间为（4.38±1.31）min，对照组肝脏悬吊时间为（8.75±1.35）min，差异有统计学意义（P<0.05）。研究组发生悬吊相关副损伤1例，为肝包膜下血肿；对照组发生悬吊相关副损伤3例，1例为肝包膜下血肿，另外2例为壁层腹膜出血；两组差异无统计学意义（P>0.05）。两组在术后肝功能变化及胃肠功能恢复情况方面比较差异均无统计学意义（P>0.05）。结论：降落伞式肝左叶悬吊装置制作简单、成本低廉、悬吊便捷、效果可靠，可作为腹腔镜胃癌根治术中肝左叶悬吊的一种新方法。

Abstract

Objective: To explore the application value of a self-made parachute-type suspension device for left lobe of liver in laparoscopic radical gastrectomy for gastric cancer. Methods: A retrospective analysis was conducted on the clinical data of 50 patients who underwent laparoscopic radical gastrectomy in the Department of Gastrointestinal Surgery at Yichang Central People's Hospital from June 2020 to June 2025. Patients were divided into two groups based on the liver lobe suspension method: the study group (n=24) used the self-made parachute-type device, while the control group (n=26) used 2-0 prolene sutures for W-type suspension. A comparative analysis of total surgical time, liver suspension time, intraoperative bleeding volume, number of lymph nodes cleared, suspension-related complications, changes in liver function after surgery, and recovery of gastrointestinal function after surgery was performed between the two groups. Results: Both liver suspension methods achieved satisfactory surgical field visibility, and there were no statistically significant differences between the two groups in total surgical time, intraoperative bleeding volume, and number of lymph nodes cleared (P>0.05). The left liver lobe suspension time was 4.38±1.31 minutes in the study group and 8.75±1.35 minutes in the control group, showing a statistically significant difference (P<0.05). The number of cases with suspension-related complications in the study group was 1, which was a subcapsular hematoma. In the control group, there were 3 cases of suspension-related complications: 1 case was a subcapsular hematoma, and the other 2 cases involved bleeding of the parietal peritoneum, with no statistically significant difference (P>0.05). There were no statistical difference between the two groups in terms of changes in liver function and recovery of gastrointestinal function after surgery (P>0.05). Conclusion: The parachute-type left liver suspension device is simple to make, low in cost, easy to suspend, and reliable in effect, and can be used as a new method for left liver suspension during laparoscopic radical gastrectomy.

关键词

胃癌根治术 / 腹腔镜手术 / 肝脏悬吊

Key words

Radical gastrectomy / Laparoscopic surgery / Liver suspension

参考文献

[1] Zhang S , Cui XM , Du T , et al. Application of a new retraction method in laparoscopic gastrectomy for gastric cancer[J]. Surg Laparosc Endosc Percutan Tech, 2023, 33(4): 431-434. DOI: 10.1097/SLE.0000000000001193.

[2] 张敬麟， 王默进， 陈心足 . 腹腔镜胃癌根治术中肝脏悬吊技术应用的进展[J]. 中国普外基础与临床杂志， 2024， 31（7）： 876-880. DOI: 10.7507/1007—9424.202403001.

[3] 王博方， 马臻， 汪学艳， 等 . 腹腔镜下肝脏悬吊方法进展[J]. 中华普通外科杂志， 2020， 35（2）： 171-173. DOI: 10.3760/cma.j.issn.1007—631X.2020.02.030.

[4] 王泽钦， 洪军， 王雅平， 等 . W型肝脏悬吊技术在全腹腔镜下全胃切除术中的应用[J]. 中华腔镜外科杂志（电子版）， 2024， 17（4）： 218-221. DOI: 10.3877/cma.j.issn.1674—6899.2024.04.005.

[5] 刘烺飚， 牛磊， 赵晓牧， 等 . 体内W型悬吊肝左叶在腹腔镜胃手术中的应用价值[J]. 中华普外科手术学杂志（电子版）， 2022， 16（3）： 275-278. DOI: 10.3877/cma.j.issn.1674—3946.2022.03.012.

[6] Wang CJ , Chao YJ , Sy ED , et al. A simple method of intracorporeal "W—shaped" liver retraction technique for minimally invasive gastric cancer surgery[J]. Surg Laparosc Endosc Percutan Tech, 2019, 29(3): e24-e28. DOI: 10.1097/SLE.0000000000000648.

[7] 张波， 王楠， 乔庆， 等 . “W”型自制肝左叶悬吊装置在全腹腔镜全胃切除术中的应用[J]. 中华胃肠外科杂志， 2022， 25（4）： 357-360. DOI: 10.3760/cma.j.cn441530—20210830—00347.

[8] Gojayev A , Yüksel C , Mercan Ü , et al. The effect and clinical significance of using Nathanson liver retractor on liver function tests in laparoscopic gastric cancer surgery[J]. Pol Przegl Chir, 2021, 94(1): 54-61. DOI: 10.5604/01.3001.0015.3544.

[9] Hiramatsu K , Aoba T , Kamiya T , et al. Novel use of the Nathanson liver retractor to prevent postoperative transient liver dysfunction during laparoscopic gastrectomy[J]. Asian J Endosc Surg, 2020, 13(3): 293-300. DOI: 10.1111/ases.12735.

[10] Takemura M , Ikebe T , Mayumi K , et al. A novel liver retraction technique for lateral lobe of the liver during laparoscopic surgery using silicone disk[J]. J Laparoendosc Adv Surg Tech A, 2011, 21(8): 729-732. DOI: 10.1089/lap.2011.0161.

[11] Sano A , Saito K , Kuriyama K , et al. Risk factors for postoperative liver enzyme elevation after laparoscopic gastrectomy for gastric cancer[J]. In Vivo, 2021, 35(2): 1227-1234. DOI: 10.21873/invivo.12373.

[12] Orr KE , Williams MP . MDCT of retractor—related hepatic injury following laparoscopic surgery: appearances, incidence, and follow—up[J]. Clin Radiol, 2014, 69(6): 606-610. DOI: 10.1016/j.crad.2014.01.008.

[13] 田利飞， 李泽雨， 赵旭， 等 . 两种肝悬吊方法在腹腔镜胃癌根治术中应用的对比研究[J]. 中华普通外科杂志， 2021， 36（4）: 263-266. DOI: 10.3760/cma.j.cn113855—20200609—00466.

[14] 刘明， 梅祎军， 潘晓明 . 肝左叶粘贴式悬吊在腹腔镜胃癌根治术中的应用[J]. 中华胃肠外科杂志， 2016， 19（3）： 343-344. DOI: 10.3760/cma.j.issn.1671—0274.2016.03.026.

[15] 计勇， 余思， 杨平， 等 . 一种新的肝脏悬吊方式在腹腔镜胃癌根治术中的应用[J]. 中华胃肠外科杂志， 2018， 21（8）： 917. DOI: 10.3760/cma.j.issn.1671—0274.2018.08.104.

基金资助

湖北省卫生健康委员会联合基金项目(WJ2019H501)