3D腹腔镜与2D腹腔镜肝切除术的对比研究
A comparative study of 3D laparoscopic versus 2D laparoscopic hepatectomy
目的 探讨3D腹腔镜在肝切除术的临床应用价值。 方法 收集2013年10月至2015年8月46例肝脏肿瘤腹腔镜肝切除术患者的临床资料，包括3D腹腔镜组22例和2D腹腔镜组24例，分析比较两组肝切除术方式、手术时间、术中出血量、术后住院时间、术后并发症等指标。 结果 3D腹腔镜组与2D腹腔组肝切除术手术方式大部分肝切除术27.3% (6例)和25% (6例)，小部分肝切除术68.2%（15例）和70.8%（17例），手术方式比较差异性无统计学意义。3D腹腔镜组肝切除术手术时间短于2D腹腔镜组（150±62 min vs 205±94 min，P=0.024），差异有统计学意义（P<0.05）。3D腹腔镜组与2D腹腔镜组术中出血量（267±233 ml vs 289±265 ml, P=0.774），术后住院时间（7.8±2.7 d vs 8.2±3.2 d，P=0.936），并发症发生情况（18.2% vs 25%，P=0.575），差异比较均无统计学意义。 结论 与2D腹腔镜比较，3D腹腔镜下清晰的三维立体视觉，解剖层次更清晰可辨，有助于肝切除术精细操作，缩短手术时间。
Objective To explore the application value of three-dimensional（3D）laparoscopic visualization during liver resection. Methods From October 2013 to August2015, 46 patients with liver tumors underwent laparoscopic hepatectomy in our department. Among these cases， 22 patients underwent laparoscopic hepatectomy (LH) by 3D laparoscope，and 24 patients underwent LH by two-dimensional (2D) laparoscope. The surgical methods of LH, the operation time and the intraoperative blood loss, postoperative hospital stay and operative complications were collected and analytic comparation was performed. Results The number of patients who underwent major hepatectomy was 6 (27.3%) in the 3D group and 6 (25%)in the 2D group，and minor hepatectomy was 15（68.2%） in 3D group and 17（70.8%） in 2D group. There was no significant difference between them，respectively. The operative time was significantly shorter in the 3D group when compared to 2D group（150±62 min vs 205±94 min，P=0.024）. No differences were found in intraoperative blood loss （267±233 ml in 3D group vs 289±265 ml in 2D, P=0.774），postoperative hospital stay（7.8±2.7 d vs 8.2±3.2 d，P=0.936），and operative complications（18.2% vs 25%，P=0.575）respectively.Conclusion When compared to 2D laparoscope，3D laparoscope that provides 3D stereoscopic visualizationcan facilitate to identify anatomical structures clearly，and be helpful to complex operations，and then may reduce the operating time.
3D 腹腔镜 / 腹腔镜肝切除术 / 手术时间 / 2D腹腔镜
3D laparoscope / Laparoscopy / hepatectomy / Operating time / 2D laparoscope
[1] Reich H, Mcglynn F, Decaprio J, et al. Laparoscopic excision of benign liver lesions[J]. Obstet Gynecol,1991,78(5 Pt 2):956-958.
[2] Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection—2,804 patients[J]. Ann Surg, 2009, 250(5):831-841.
[3] 陈海金，俞金龙，黄宗海，等. 3D高清腹腔镜在腹腔镜胃癌根治术中的应用[J]. 南方医科大学学报, 2014, 34(4):588-590.
[4] Alaraimi B, El Bakbak W, Sarker S, et al. A randomized prospective study comparing acquisition of laparoscopic skills in three-dimensional (3D) vs. two-dimensional (2D) laparoscopy[J]. World J Surg, 2014, 38(11):2746-2752.
[5] 中华医学会外科学分会肝脏外科学组. 腹腔镜肝切除专家共识与手术操作指南(2013版)[J]. 中华消化外科杂志, 2013,12(3):161-165.
[6] Wakabayashi G, Cherqui D, Geller DA, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka[J]. Ann Surg, 2015, 261(4):619-629.
[7] Tranchart H, Dagher I. Laparoscopic liver resection: a review[J]. J Visc Surg, 2014, 151(2):107-115.
[8] Yin Z, Fan X, Ye H, et al. Short- and long-term outcomes after laparoscopic and open hepatectomy for hepatocellularcarcinoma: a global systematic review and meta-analysis[J]. Ann Surg Oncol, 2013, 20(4):1203-1215.
[9] Ishizawa T, Gumbs AA, Kokudo N, et al. Laparoscopic segmentectomy of the liver[J]. Ann Surg, 2012, 256(6):959-964.
[10] Tsung A, Geller DA, Sukato DC, et al. Robotic versus laparoscopic hepatectomy[J]. Ann Surg, 2014, 259(3):549-555.
[11] 赵大川，黄宗海，邹兆伟. 3D腹腔镜系统的临床应用进展[J]. 南方医科大学学报, 2014, 34(4):594-597.
[12] 张红卫，李闻达，曹君，等. 3D腹腔镜下解剖性肝切除术治疗肝脏肿瘤的应用价值[J]. 中华肝脏外科手术学电子杂志, 2014, 3(3):152-156.
[13] 方驰华，方兆山，范应方，等. 三维可视化、3D打印及3D腹腔镜在肝肿瘤外科诊治中的应用[J]. 南方医科大学学报, 2015, 35(5):639-645.
[14] Ashraf A, Collins D, Whelan M, et al. Three-dimensional (3D) simulation versus two-dimensional (2D) enhances surgical skills acquisition in standardised laparoscopic tasks: A before and after study[Z]. 2015.14,12-16.
[15] Wilhelm D, Reiser S, Kohn N, et al. Comparative evaluation of HD 2D/3D laparoscopic monitors and benchmarking to a theoretically ideal 3D pseudodisplay: even well-experienced laparoscopists perform better with 3D[J]. Surg Endosc, 2014, 28(8):2387-2397.
[16] Sinha R, Sundaram M, Raje S, et al. 3D laparoscopy: technique and initial experience in 451 cases[J]. Gynecological Surgery, 2013,10(2):123-128.
[17] Kyriazis I, Ozsoy M, Kallidonis P, et al. Integrating three-dimensional vision in laparoscopy: the learning curve of an expert[J]. J Endourol, 2015, 29(6):657-660.
[18] 范应方，项楠. 3D腹腔镜胆囊切除术治疗胆囊结石1例并文献复习[J]. 南方医科大学学报, 2013, 33(12):1856-1857.
[19] 晏益核，卢榜裕，蔡小勇，等. 腹腔镜下肝门血流阻断肝切除术的解剖学基础[J]. 中国临床解剖学杂志, 2012, 30(5):494-497.
[20] Machado MA, Makdissi FF, Galvão FH, et al. Intrahepatic glissonian approach for laparoscopic right segmental liver resections[J]. Am J Surg, 2008,196(4):e38-e42.
[21] Topal B, Aerts R, Penninckx F. Laparoscopic intrahepatic Glissonian approach for right hepatectomy is safe, simple, and reproducible[J]. Surg Endosc, 2007, 21(11):2111.
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