Wang Xun, Meng Xuan, Wang Liming, Wang Peng, Wang Zhihao, Rong Weiqi, Lu Zhiyu, Wang Hongguang
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
ILIVER. 2024 Jul 5;3(3):100106. doi: 10.1016/j.iliver.2024.100106. eCollection 2024 Sep.
Laparoscopic hepatectomy is challenging, and ultrasound guidance is an effective aid but lacks standardization. This study aimed to evaluate a modified approach for laparoscopic ultrasonography to enhance surgical outcomes.
Between January 2020 and August 2023, 122 patients who underwent real-time ultrasound-guided laparoscopic anatomical hepatectomy for hepatocellular carcinoma were enrolled and divided into modified and traditional ultrasonography groups. The modified ultrasound application comprised intraoperative protocol-based laparoscopic ultrasonography comprising application scenarios; standardized positions for the surgeon, trocar, and probe; and the resulting standardized sections for various laparoscopic liver resections. Clinical characteristics and perioperative outcomes were compared between the two groups. Subgroup analysis was performed and comprised techniques for modified duct structure identification and portal vein branch puncture; both techniques were used in fluorescence probe-mounted laparoscopic liver resection using negative and positive staining procedures, respectively.
The traditional and modified groups comprised 64 and 58 patients, respectively. The patients' background characteristics were not significantly different between the groups. Surgical duration (283.4 min vs. 225.1 min; < 0.001), Pringle maneuver duration (47.4 min vs. 39.5 min; = 0.014), bleeding volume (258.6 mL vs. 174.8 mL; = 0.005), overall complication rate (31.3% vs. 15.5%; = 0.041), and postoperative stay were significantly greater in the traditional vs. modified ultrasonography groups, respectively. The modified method positively affected the number of punctures, success rate of staining, intraoperative bleeding volume, and operation duration.
Modified ultrasonography improves the safety and effectiveness of laparoscopic hepatectomy. Ultrasonography is pivotal, especially in fluorescence probe-assisted laparoscopic liver resection.
腹腔镜肝切除术具有挑战性，超声引导是一种有效的辅助手段，但缺乏标准化。本研究旨在评估一种改良的腹腔镜超声检查方法，以提高手术效果。
在2020年1月至2023年8月期间，纳入122例行实时超声引导下腹腔镜解剖性肝切除术治疗肝细胞癌的患者，并分为改良超声检查组和传统超声检查组。改良超声应用包括基于术中方案的腹腔镜超声检查，涵盖应用场景；外科医生、套管针和探头的标准化位置；以及各种腹腔镜肝切除术的标准化切面。比较两组的临床特征和围手术期结果。进行亚组分析，包括改良胆管结构识别和门静脉分支穿刺技术；这两种技术分别用于荧光探头辅助腹腔镜肝切除术中的阴性和阳性染色程序。
传统组和改良组分别有64例和58例患者。两组患者的背景特征无显著差异。传统超声检查组与改良超声检查组相比，手术时间（283.4分钟对225.1分钟；<0.001）、Pringle手法时间（47.4分钟对39.5分钟；=0.014）、出血量（258.6毫升对174.8毫升；=0.005）、总体并发症发生率（31.3%对15.5%；=0.041）和术后住院时间均显著更长。改良方法对穿刺次数、染色成功率、术中出血量和手术持续时间有积极影响。
改良超声检查可提高腹腔镜肝切除术的安全性和有效性。超声检查至关重要，尤其是在荧光探头辅助腹腔镜肝切除术中。
