[1]郑学静 桑庆 王亮 陈冠阳 张能维*.克氏针挡肝技术在减重手术中的应用：附110例报告[J].中国微创外科杂志,2020,01(8):700-703.
　Zheng Xuejing,Sang Qing,Wang Liang,et al.Use of Kwire Liver Retracting Technique in Metabolic Surgery: Experience of 110 Cases[J].Chinese Journal of Minimally Invasive Surgery,2020,01(8):700-703.
点击复制

克氏针挡肝技术在减重手术中的应用：附110例报告()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年8期
页码:
700-703
栏目:
临床研究
出版日期:
2020-08-25

文章信息/Info

Title:
Use of Kwire Liver Retracting Technique in Metabolic Surgery: Experience of 110 Cases
作者:
郑学静 桑庆 王亮 陈冠阳 张能维*
(北京大学第九临床医学院糖尿病外科治疗中心，北京100038)
Author(s):
Zheng Xuejing;  Sang Qing;  Wang Liang;  et al.
Surgery Centre of Diabetes Mellitus, Ninth Clinical Hospital, Peking University, Beijing 100038, China
关键词:
肝左外叶; 克氏针; 减重手术; 肝脏牵拉技术
Keywords:
Left lateral lobe of liver; Kwire; Obesity surgery; Liver retracting technique
文献标志码:
A
摘要:
目的探讨腹腔镜下减重手术中克氏针挡肝技术的可行性及安全性。方法2019年1~9月我科在110例减重手术中采用克氏针挡肝技术完成肝脏牵拉：腹腔镜直视下以克氏针在剑突下2 cm左侧穿刺腹壁，肠钳挑起肝脏后将克氏针经肝下置于膈肌脚从而抬起肝脏、暴露术野。结果110例克氏针挡肝技术均获得良好的术野暴露，无须其他肝脏牵拉技术。完成克氏针挡肝时间(34.4±10.1) s，手术时间(88.2±28.0) min，术中出血中位数20(10，50) ml。术中均未发现肝刺裂伤、肝包膜下血肿等并发症。术后均未发现穿刺点再出血、感染等克氏针挡肝技术相关并发症，均未出现吻合口出血、胃漏及吻合口漏等严重手术并发症。术后住院时间(3.6±1.2) d，住院费用(62 383.7±10 021.2)元。术前ALT、AST分别为44.0(25.8，71.8) U/L、28.0(19.0，45.3) U/L，显著低于术后第1天AST、ALT分别为51.5(30.8，83.0) U/L、41.0(26.0，635) U/L(P均=0.000)；术后1个月ALT、AST分别为42.5(29.0，67.0) U/L、29.0(22.0，43.0) U/L，与术前比较差异均无显著性(P=0.634，P=0.784)。结论在减重手术中，克氏针挡肝技术安全、可行，可以作为一种常规的肝脏牵拉技术。
Abstract:
ObjectiveTo explore the safety and feasibility of the kwire liver retracting technique during obesity surgery.MethodsA retrospective review was performed on 110 patients undergoing obesity surgery from January 2019 to September 2019. The Kwire was used to retract the left lobe of liver in all the cases. The kwire was introduced leftwards at 2 cm inferior to the xiphoid under laparoscopic visualization. The liver was retracted anterior to the abdominal wall by bowel clamp and then the kwire was directed underneath the liver at the diaphragmatic crura to expose the operative field.ResultsThe kwire liver retracting technique could maintain an adequate operative field in all the cases, without convention to other liver retracting techniques. It took (34.4±101) seconds to finish the liver retracting technique. The mean operating time was (88.2±28.0) minutes, and the median operative bleeding was 20 (10, 50) ml. No case of puncturesite related bleeding or infection happened. And no case of anastomotic bleeding or leakage happened. The postoperative hospital stay was (3.6±1.2) days, and the total hospitalization costs were (62 383.7±10 021.2) yuan. The ALT and AST levels of 110 patients were 44.0 (25.8, 71.8) U/L and 28.0 (19.0, 45.3) U/L before operation and 51.5 (30.8, 83.0) U/L and 41.0 (26.0, 63.5) U/L on the first day postoperatively and 42.5 (29.0, 67.0) U/L and 29.0 (22.0, 43.0) U/L at the first month postoperatively, respectively, with statistically significant differences between before operation and on the first day(all P=0.000), and no statistical significant differences between before operation and at the first month postoperatively(P=0.634,P=0.784). ConclusionThe kwire liver retracting technique is safe and feasible in obesity surgery, and it can be used as a routine liver retracting technique.

参考文献/References:

[1]中华医学会外科学分会甲状腺及代谢外科学组,中国医师协会外科医师分会肥胖和糖尿病外科医师委员会.中国肥胖和2型糖尿病外科治疗指南(2019版).中国实用外科杂志,2019,39 (4)：301-306.
[2]孟化,刘洋,郭伟,等.经脐单孔腹腔镜袖状胃切除术(附14 例报告).腹腔镜外科杂志,2016,21(1):36-40.
[3]Arias Amezquita F, Prada Ascencio NE, Gomez D,et al. Transumbilical sleeve gastrectomy. Obes Surg,2010,20(2):232-235.
[4]刘金刚,郑成竹,王勇.中国肥胖和2型糖尿病外科治疗指南(2014).中国实用外科杂志,2014,8(11):1005-1010.
[5]Harari AA, Hochman B, Bessler M. A new technique for intracorporeal liver retraction in laparoscopic surgery. Surg Obes Relat Dis,2013,9(1):143.
[6]Nathanson LK, Cuschieri A. The falciform lift: a simple method for retraction of the falciform ligament during laparoscopic cholecystectomy. Surg Endosc,1990,4(3):186.
[7]Suwa T, Yoshida M, Kubota K, et al. A new procedure with stomachlifting techniques to simplify laparoscopyassisted distal gastrectomy and extraperigastric lymph node dissection for gastric cancer. Surg Today,2009,39(1):83-87.
[8]de la Torre RA, Satgunam S, Morales MP, et al. Transumbilical singleport laparoscopic adjustable gastric band placement with liver suture retractor. Obes Surg,2009,19(12):1707-1710.
[9]Zachariah SK, Tai CM, Chang PC, et al. The "Tsuspension tape" for liver and gallbladder retraction in bariatric surgery: feasibility, technique, and initial experience. J Laparoendosc Adv Surg Tech A,2013,23(4):311-315.
[10]刘明,梅袆君,潘晓明.肝左叶粘贴式悬吊在腹腔镜胃癌根治术中的应用.中华胃肠外科杂志,2016,19(3):343-344.
[11]Huang CK, Lo CH, Asim S, et al. A novel technique for liver retraction in laparoscopic bariatric surgery. Obes Surg,2011,21(5):676-679.
[12]Gan P, Bingham J. A clinical study of the LiVac laparoscopic liver retractor system. Surg Endosc,2015,30(2):789-796.
[13]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 Laparoendosc Adv Surg Tech A,2011,21(8):729-732.
[14]王亮,张璇,李震,等.脐内2 cm小切口单孔腹腔镜胃袖状切除术8例体会.中国微创外科杂志,2018,18(11):993-1022.
[15]王亮, 张璇, 李震,等. 三孔腹腔镜胃袖状切除术:附18例报告.中国微创外科杂志,2018,18(9):792-796.
[16]肖刚,于宏.单孔腹腔镜手术中肝脏牵拉方法的应用进展.中国微创外科杂志,2019,19(1):72-76.
[17]Kinjo Y, Okabe H, Obama K, et al. Elevation of liver function tests after laparoscopic gastrectomy using a nathanson liver retractor. World J Surg,2011,35(12):2730-2738.
[18]Goel R, Shabbir A, Tai CM, et al. Randomized controlled trial comparing three methods of liver retraction in laparoscopic RouxenY gastric bypass. Surg Endosc,2013,27(2):679-684.
[19]吴硕东,姚殿波,孙余田.肝左外叶粘贴式悬吊在单孔腹腔镜左季肋区手术中的应用价值.中华消化外科杂志,2018,17(5):497-501.

备注/Memo

备注/Memo:
*通讯作者，Email：zhangnw1@sohu.com
更新日期/Last Update: 2020-11-13