中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (03): 329-333.DOI: 10.19538/j.cjps.issn1005-2208.2025.03.17

• 论著 • 上一篇    下一篇

“双主刀”模式在高难度腹腔镜肝切除术中的应用价值研究

高    淼1，孟凡征2，宋华传2，张珅瑜2，王永帅2，刘连新2，王继洲2，宋瑞鹏1，2   

  1. 1蚌埠医科大学，安徽蚌埠233000；2中国科学技术大学附属第一医院肝胆外科，安徽合肥230036
  • 出版日期:2025-03-01 发布日期:2025-03-27

  • Online:2025-03-01 Published:2025-03-27

摘要： 目的    比较“双主刀”与“单主刀”模式在行高难度腹腔镜肝切除术治疗肝细胞癌（HCC）病人中的应用价值。方法  回顾性分析2021年1月至2023年9月在中国科学技术大学附属第一医院接受腹腔镜肝切除术的HCC病人临床资料，根据手术模式分为“双主刀”组（35例）和“单主刀”组（39例）。比较两组病人的手术时间、术中失血量、术中输血率、肝门阻断时间及术后并发症发生率等围手术期指标。结果    在高难度手术中，“双主刀”组的手术时间显著短于“单主刀”组［（199.5±50.4）min vs.（254.4±82.9）min，P=0.001］，术后第3天丙氨酸转氨酶水平更低［101.80（32.80，834.60）U/L vs. 159.10（21.10，1005.00）U/L，P=0.027］，术中失血量更少［100.0（100.0，200.0）mL vs. 200.0（100.0，400.0）mL，P=0.001］；但“双主刀”组的住院费用显著高于“单主刀”组（P=0.025）。两组术中输血率、肝门阻断时间及术后并发症发生率差异无统计学意义。结论    在高难度腹腔镜肝切除术中，“双主刀”模式可在保证围手术期安全性的同时缩短手术时间并减少术中出血并促进肝功能恢复。

关键词: 肝细胞癌, 腹腔镜肝切除术, 双主刀模式, 围手术期疗效

Abstract: To compare the perioperative efficacy of the two-surgeon technique (TST) and single-surgeon technique (SST) in treating hepatocellular carcinoma (HCC) through difficult laparoscopic hepatectomy. Methods  Clinical data of HCC patients undergoing laparoscopic hepatectomy at the First Affiliated Hospital of the University of Science and Technology of China between January 2021 and September 2023 were retrospectively analyzed. Patients were divided into the TST (n=35) and SST (n=39) groups. Key perioperative outcomes, including operative time, intraoperative blood loss, transfusion rate, hilar occlusion time, and postoperative complication rates, were compared between the two groups. Results    In high-difficult cases, the operative time was significantly shorter in the TST group compared to the SST group ［(199.5±50.4) min vs. (254.4±82.9) min, P=0.001］, and intraoperative blood loss was significantly reduced ［100.0 (100.0, 200.0) mL vs. 200.0 (100.0, 400.0) mL, P=0.001］. The level of alanine aminotransferase was lower on the third day after the operation［101.80（32.80，834.60）U/L vs. 159.10（21.10，1005.00）U/L，P=0.027］. However, the hospitalization costs of the TST group were higher than those of the SST group (P=0.025). There were no significant differences in transfusion rate, hilar occlusion time, or postoperative complication rates between the two groups. Conclusion    The TST demonstrates comparable safety in complex laparoscopic hepatectomy while offering advantages of shorter operative time and reduced intraoperative blood loss and promote the recovery of liver function.

Key words: hepatocellular carcinoma, laparoscopic hepatectomy, two-surgeon technique, perioperative outcomes