探讨统筹干预在肝左外叶切除术中的应用价值。

回顾性分析2010年10月至2013年10月在兰州大学第二医院行肝左外叶切除术的49例患者临床资料。根据患者有否进行统筹干预，分为统筹组和对照组。其中统筹组29例，男16例，女13例；年龄44～71岁，中位年龄56岁。对照组20例，男12例，女8例；年龄48～69岁，中位年龄54岁。所有患者均签署知情同意书，符合医学伦理学规定。所有患者均在不阻断第一肝门情况下行肝左外叶切除术，手术人员均为同一组手术医师。统筹组配备固定的肝脏手术器械护士、手术间及大型器械管理调试护士，开腹前、术中、关腹3个过程中统筹干预。对照组手术医师和护士随机组合。两组手术时间、术中出血量比较采用t检验。

两组患者均手术顺利。统筹组平均手术时间、术中出血量分别为（87±11）min、（203±50）ml，明显低于对照组的（153±20）min、（385±61）ml（t=-5.647，-5.436；P<0.05）。两组患者术后均无发生死亡，无手术断面出血、肝衰竭等严重并发症。

统筹干预有助于缩短肝左外叶切除术的手术时间，并减少术中出血量。

To investigate the application value of overall intervention in hepatic left lateral lobectomy.

Clinical data of 49 patients undergoing hepatic left lateral lobectomy in Lanzhou University Second Hospital from October 2010 and October 2013 were retrospectively analyzed. The patients were divided into the overall intervention group and control group. Twenty-nine cases were enrolled in the overall intervention group, including 16 males and 13 females, aged from 44 to 71 years with a median age of 56 years. Twenty cases were enrolled in the control group, including 12 males and 8 females, aged from 48 to 69 years with a median age of 54 years. The informed consents of all patients were obtained and the local ethical committee approval had been received. All patients underwent hepatic left lateral lobectomy without first hepatic portal control, which was performed by the surgeons from the same group. In the overall intervention group, regular nurses responsible for hepatic operating set, operating room and nurses in charge of large-sized equipments were assigned. Overall intervention was performed before the abdomen opening, duration and closing of operation. In the control group, surgeons and nurses were assigned at random. Operative duration and intraoperative blood loss of two groups were compared using t test.

All patients completed the operation successfully. The average operative duration and intraoperative blood loss in the overall intervention group were (87±11) min and (203±50) ml, which were significantly lower than (153±20) min and (385±61) ml in the control group (t=-5.647, -5.436; P<0.05). No death case, cut surface hemorrhage or liver failure was observed in both groups postoperatively.

Overall intervention helps to shorten the operative duration and reduce the blood loss in hepatic left lateral lobectomy.