猪腹腔镜下左半肝切除术联合右外侧肝叶切除术:手术方法及与开放手术相比的炎症反应研究
Laparoscopic left hemihepatectomy combined with right lateral hepatic lobectomy in pigs: surgical approach and comparative study of the inflammatory response versus open surgery.
作者信息
Zhang Hua, Tong Jin-Jin, Zhang Zhao-Nan, Wang Hong-Bin, Zhang Yong-Hong
机构信息
Department of Animal Science, College of Animal Science and Technology, Beijing University of Agriculture, Beijing, China.
Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin, China.
出版信息
Vet Res Forum. 2021 Winter;12(1):1-6. doi: 10.30466/vrf.2019.105865.2518. Epub 2021 Mar 15.
This study describes a left hemihepatectomy combined with a right lateral hepatic lobectomy. It compares the inflammatory response associated with laparoscopic hepatectomy (LH group, n = 7) with conventional open hepatectomy (OH group, n = 7). Blood was collected before surgery as well as 1, 2, 3, 5, and 7 days after surgery to determine the white blood cell count and levels of serum cortisol (COR), interleukin-6 (IL-6), and C-reactive protein (CRP). The left hemi-hepatectomy combined with a right lateral hepatic lobectomy was completed in miniature pigs. The average operative time was 139.00 ± 9.07 min, which was longer than that in the OH group (121.67 ± 3.02 min). The length of surgical incision associated with the OH group was 17.93 ± 1.09 cm, significantly longer than that related to the LH group (5.10 ± 0.17 cm). The estimated mean blood loss in the LH group was 136.43 ± 63.24 mL, which was significantly lower than that in the OH group. No severe complications (e.g., massive bleeding, bile leakage, and air embolism) were reported. The CRP levels, COR, and IL-6, increased significantly in the OH group and then slowly returned to their preoperative levels. A postoperative laparoscopic exploration revealed that the incised portion of the liver adhered to the omentum, but no additional abnormalities were observed. These findings indicate that a 4-trocar method for laparoscopic left hemihepatectomy combined with a right lateral hepatic lobectomy is safe and feasible. The inflammatory response for those receiving LH are lower than that for those receiving OH. This porcine model can be used as a research analog for liver disease and regeneration.
本研究描述了左半肝切除术联合右肝外侧叶切除术。比较了腹腔镜肝切除术(LH组,n = 7)与传统开放性肝切除术(OH组,n = 7)相关的炎症反应。在手术前以及手术后1、2、3、5和7天采集血液,以测定白细胞计数以及血清皮质醇(COR)、白细胞介素-6(IL-6)和C反应蛋白(CRP)水平。在小型猪身上完成了左半肝切除术联合右肝外侧叶切除术。平均手术时间为139.00±9.07分钟,比OH组(121.67±3.02分钟)长。OH组的手术切口长度为17.93±1.09厘米,明显长于LH组(5.10±0.17厘米)。LH组估计平均失血量为136.43±63.24毫升,明显低于OH组。未报告严重并发症(如大出血、胆漏和气栓)。OH组的CRP水平、COR和IL-6显著升高,然后缓慢恢复到术前水平。术后腹腔镜探查显示肝脏切开部分与大网膜粘连,但未观察到其他异常。这些发现表明,采用四套管法进行腹腔镜左半肝切除术联合右肝外侧叶切除术是安全可行的。接受LH治疗者的炎症反应低于接受OH治疗者。这种猪模型可作为肝病和肝脏再生研究的类似模型。
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