Harumatsu Toshio, Nagai Taichiro, Yano Keisuke, Onishi Shun, Yamada Koji, Yamada Waka, Matsukubo Makoto, Muto Mitsuru, Kaji Tatsuru, Ieiri Satoshi
Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan.
Clinical Training Center, Kagoshima University Hospital, Kagoshima, Japan.
Pediatr Surg Int. 2020 May;36(5):591-596. doi: 10.1007/s00383-020-04646-8. Epub 2020 Mar 20.
Liver retraction during laparoscopic fundoplication is important for obtaining an optimal space. Several methods have been developed, but the risks and benefits are unclear. We compared three different approaches and evaluated their safety and utility.
Forty-three neurologically impaired patients who underwent laparoscopic fundoplication between 2005 and 2018 were classified into three groups: A, snake retractor method, n = 18; B, crural suture method, n = 13; C, needle grasper method, n = 12. Patients' characteristics and outcomes were reviewed.
The liver retraction time was significantly shorter in group C than in A or B (p < 0.05). The operative times were shorter in groups B and C than in A. There were no significant differences in the liver enzyme levels. The liver enzyme levels increased temporarily but improved within a week. The C-reactive protein levels were significantly lower in group B than in A or C (p < 0.05).
The most convenient method was the needle grasper method, as the other two approaches create conflict with the operator's forceps. The crural suture method damages the liver less, but requires higher surgical skill levels. It is important to select the appropriate method according to the operator's skill and the patient's size and deformity.
腹腔镜胃底折叠术中肝脏牵拉对于获得最佳手术空间很重要。已开发出多种方法，但风险和益处尚不清楚。我们比较了三种不同方法并评估了它们的安全性和实用性。
将2005年至2018年间接受腹腔镜胃底折叠术的43例神经功能受损患者分为三组：A组，蛇形牵开器法，n = 18；B组，膈肌脚缝合术，n = 13；C组，针状抓钳法，n = 12。回顾患者的特征和手术结果。
C组的肝脏牵拉时间明显短于A组或B组（p < 0.05）。B组和C组的手术时间短于A组。肝酶水平无显著差异。肝酶水平暂时升高，但在一周内有所改善。B组的C反应蛋白水平明显低于A组或C组（p < 0.05）。
最便捷的方法是针状抓钳法，因为其他两种方法会与术者的钳子产生冲突。膈肌脚缝合术对肝脏的损伤较小，但需要更高的手术技巧水平。根据术者的技能以及患者的体型和畸形情况选择合适的方法很重要。
