Department of Gastrointestinal Surgery, Osaka International Cancer Institute, 3-1-69 Ohtemae, Chuo-ku, Osaka, 541-8567, Japan.
Surg Endosc. 2019 Jun;33(6):1828-1836. doi: 10.1007/s00464-018-6461-0. Epub 2018 Oct 3.
Retracting the lateral liver segment during laparoscopic distal gastrectomy is important for achieving an optimal surgical field. However, excessive force may injure the liver, causing temporary abnormalities of liver function tests after laparoscopic surgery. We developed a new liver retraction method and assessed its safety and utility.
We retrospectively analyzed records in our surgical database of consecutive surgical patients who underwent laparoscopic distal gastrectomy for early gastric cancer. We divided the 229 patients into two groups based on the liver retraction method used, either flexible liver retraction with clipping and suturing (FLICS) or the Nathanson retractor (NR). One-to-one propensity score matching was performed to match patients, resulting in the records of 53 pairs of cases extracted from the database. Operative and postoperative outcomes were assessed, including following the values of serum liver enzymes, total bilirubin, and C-reactive protein until postoperative day 30.
There were no significant differences in patient characteristics or preoperative data in the two groups. The retraction method was not changed intraoperatively for any patients. The operative time was significantly shorter in the FLICS group, but the amount of bleeding did not differ. Liver injury was not observed as a result of liver retraction during surgery. In both groups, serum liver enzymes temporarily increased after surgery but improved rapidly thereafter. The postoperative increases in aspartate transaminase, alanine transaminase, and C-reactive protein levels were significantly lower in the FLICS than in the NR group. No serious complications associated with liver retraction were observed in either group.
Our new liver retraction technique provided an optimal surgical field without inducing liver dysfunction. It is a simple, safe, and effective liver retraction technique.
在腹腔镜远端胃切除术中，牵拉外侧肝段对于获得最佳手术视野非常重要。然而，过度用力可能会损伤肝脏，导致腹腔镜手术后肝功能试验暂时异常。我们开发了一种新的肝脏牵拉方法，并评估了其安全性和实用性。
我们回顾性分析了连续接受腹腔镜远端胃癌根治术治疗早期胃癌的患者的手术数据库记录。我们根据使用的肝脏牵拉方法将 229 例患者分为两组，即夹闭和缝合的柔性肝脏牵拉（FLICS）或 Nathanson 牵开器（NR）。采用 1:1 倾向评分匹配法对患者进行匹配，从数据库中提取了 53 对病例记录。评估了手术和术后结果，包括术后 30 天内血清肝酶、总胆红素和 C 反应蛋白的变化。
两组患者的特征和术前数据无显著差异。术中没有改变任何患者的牵拉方法。FLICS 组的手术时间明显缩短，但出血量无差异。手术过程中没有因肝脏牵拉而导致肝脏损伤。两组患者术后血清肝酶均暂时升高，但随后迅速改善。FLICS 组术后天门冬氨酸转氨酶、丙氨酸转氨酶和 C 反应蛋白水平升高幅度明显低于 NR 组。两组均未观察到与肝脏牵拉相关的严重并发症。
我们的新肝脏牵拉技术在不引起肝功能障碍的情况下提供了一个最佳的手术视野。它是一种简单、安全、有效的肝脏牵拉技术。
