Department of Surgery, Yonsei University College of Medicine, 134 Shinchon-dong Seodaemun-ku, Seoul 120-752, Republic of Korea.
Surg Endosc. 2011 Dec;25(12):3939-45. doi: 10.1007/s00464-011-1788-9. Epub 2011 Jun 8.
Prolonged liver retraction during radical gastrectomy for adequate exposure of the hepatogastric ligament may lead to hepatic trauma. The authors offer a new minimally traumatic liver retraction method using a simple liver suspension with a gauze suture and compare it with the modified liver-puncture method.
This study retrospectively evaluated 92 patients who underwent the liver-suspension or liver-puncture method during gastric resections in 2010. Their clinical and operative characteristics were analyzed together with perioperative transaminases, and the two groups were compared. Patients with a history of liver disease, abnormal preoperative liver function test results, postoperative complications, or combined operations were excluded from the study. The liver-suspension method was performed using two 4 × 4-in. gauze pads threaded with a 2-0 Prolene suture, which were secured to the pars condensa with surgical clips and externally tied to suspend the liver toward the abdominal wall.
Each liver retraction was completed without intraoperative complications. The patients in the liver-suspension group had more nonhepatic comorbidities than those in the liver-puncture group (P = 0.029). Other patient characteristics such as age, gender, and body mass index (BMI) did not differ between the two groups. No differences were found between the groups in terms of mean operative time (200.3 ± 66.9 vs 214.9 ± 74.4) or preoperative mean alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels. However, the patients in the liver-suspension group had significantly lower postoperative mean ALT levels (postoperative days 0, 1, 2, 3, and 5) and mean AST levels (postoperative days 0 and 1).
Compared with the liver-puncture method, the authors' novel liver-suspension with suture-gauze technique is a safe and effective method for retracting the liver during laparoscopic and robotic upper abdominal surgeries.
在根治性胃切除术中，为充分暴露肝胃韧带而长时间牵拉肝脏可能导致肝损伤。作者提供了一种新的微创性肝牵拉方法，使用带有纱布缝线的简单肝悬吊，并与改良的肝穿刺方法进行比较。
本研究回顾性评估了 2010 年接受胃切除术中肝悬吊或肝穿刺的 92 例患者。分析了他们的临床和手术特点以及围手术期转氨酶，并对两组进行了比较。排除有肝脏疾病病史、术前肝功能检查异常结果、术后并发症或联合手术的患者。肝悬吊法采用两块 4×4 英寸的纱布垫，用 2-0 prolene 缝线穿过，用手术夹固定在 condensa 区，并向外系紧以将肝脏悬向腹壁。
每个肝脏牵拉均在无术中并发症的情况下完成。肝悬吊组患者的非肝脏合并症多于肝穿刺组（P = 0.029）。两组患者的年龄、性别和体重指数（BMI）等其他患者特征无差异。两组患者的手术时间（200.3±66.9 与 214.9±74.4）或术前平均丙氨酸转氨酶（ALT）或天冬氨酸转氨酶（AST）水平均无差异。然而，肝悬吊组患者术后平均 ALT 水平（术后第 0、1、2、3 和 5 天）和平均 AST 水平（术后第 0 和 1 天）明显较低。
与肝穿刺法相比，作者新的带缝线纱布的肝悬吊技术是腹腔镜和机器人上腹部手术中安全有效的肝牵拉方法。
