中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (03): 334-339.DOI: 10.19538/j.cjps.issn1005-2208.2025.03.18

• 论著 • 上一篇    下一篇

可单手操作肝蒂阻断钳在腹腔镜肝切除术中应用研究

沈正超1，2，储鸿鹏2，蒋    彬2，王冠男2，方小三2，王    杰2，王小明1，2   

  1. 1安徽医科大学第五临床医学院，安徽合肥 230000；2皖南医学院第一附属医院肝胆二科，安徽芜湖241000
  • 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    评估可单手操作的肝蒂阻断钳在腹腔镜肝切除术中的应用价值，分析其对手术流程优化及术后效果的影响。方法    回顾性分析2019年3月至2023年2月期间43例在皖南医学院第一附属医院接受腹腔镜肝肿瘤切除手术的病人临床资料。手术中均采用自制的肝蒂阻断钳进行第一肝门阻断，记录术中阻断时间、手术时间、术中失血量、术后住院时间及并发症发生率等指标。结果    所有病人均顺利完成手术，无须中转开放手术。术中使用肝蒂阻断钳对第一肝门血流实施间歇性阻断（15 min阻断、5 min松解），中位阻断次数为4次，中位阻断时间为60 min。平均手术时间为（318.1±113.6）min，平均术中失血量为（535.1±395.5）mL，平均术后住院时间为（8.2±4.1）d。术后并发症发生率为11.6%，均为Clavien-DindoⅠ级或Ⅱ级，无Ⅲa级及以上并发症或死亡病例。所有病人术后未发生门静脉血栓或肝动脉瘤。结论    可单手操作的肝蒂阻断钳使用简便，有助于优化腹腔镜肝切除术的流程，可靠地实现肝门血流阻断，显著减少术中出血和术后并发症。该器械为腹腔镜肝切除术提供了一种安全、有效且便捷的工具，具有广泛的临床应用潜力。

关键词: 肝蒂阻断钳, 腹腔镜肝切除术, 肝门血流阻断, 术中失血量, 术后并发症, 手术时间, 住院时间

Abstract: To evaluate the clinical utility of a single-hand-operable hepatic pedicle clamp in laparoscopic hepatectomy and analyze its impact on surgical workflow optimization and postoperative outcomes. Methods    A retrospective analysis was conducted on the clinical data of 43 patients who underwent laparoscopic liver tumor resection at the First Affiliated Hospital of Wannan Medical College between March 2019 and February 2023. The hepatic pedicle clamp, self-developed for single-hand operation, was used for intermittent occlusion of the first hepatic portal during surgery. Key recorded metrics included occlusion time, operative time, intraoperative blood loss, postoperative hospital stay, and complication rates. Results    All procedures were successfully completed without conversion to open surgery. The hepatic pedicle clamp enabled effective intermittent occlusion of blood flow to the first hepatic portal (15 minutes of occlusion followed by 5 minutes of release), with a median occlusion frequency of 4 times and a median occlusion time of 60 minutes. The mean operative time was (318.1±113.6) minutes, the mean intraoperative blood loss was (535.1±395.5) mL, and the mean postoperative hospital stay was (8.2±4.1) days. The postoperative complication rate was 11.6%, all classified as Clavien-Dindo grade I or Ⅱ. No grade Ⅲa or higher complications or mortality were observed. Additionally, no postoperative portal vein thrombosis or hepatic artery aneurysm occurred in any patient. Conclusion    The single-hand-operable hepatic pedicle clamp is simple to use, facilitates workflow optimization in laparoscopic hepatectomy, and reliably achieves hepatic portal blood flow occlusion. Its use significantly reduces intraoperative blood loss and postoperative complications. This device offers a safe, effective, and convenient tool for laparoscopic hepatectomy and holds significant potential for widespread clinical applications.

Key words: hepatic pedicle clamp, laparoscopic hepatectomy, portal blood flow occlusion, intraoperative blood loss, postoperative complications, operative time, hospital stay