分析两种托肝方式在腹腔镜食管裂孔疝修补术中的效果应用。

收集2022年12月至2024年12月河北省清河县中心医院普外科行因食管裂孔疝行腹腔镜食管裂孔疝手术的患者36例，其中16例患者采用剑突下置入无损伤抓钳（抓钳组）进行托肝，20例患者采用剑突下置入专用托肝器械（器械组）进行托肝，对2组数据进行回顾性分析，明确不同托肝方式在腹腔镜食管裂孔疝修补术中效果。

36例患者均顺利完成手术，2组患者性别、年龄和体重指数比较，差异无统计学意义（P>0.05）。抓钳组托肝安装时间低于器械组托肝安装时间，差异有统计学意义（P<0.05）。组间对比，2组间术前、术后1 d及出院前血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）及总胆红素水平差异无统计学意义（P>0.05）。组内比较，2组内术后1 d血清ALT、AST水平高于术前，差异有统计学意义（P<0.05），术后1 d总胆红素水平与术前差异无统计学意义（P>0.05）；出院前血清ALT、AST水平低于术后1 d，差异有统计学意义（P<0.05），出院前总胆红素水平与术后1 d差异无统计学意义（P>0.05）；出院前血清ALT、AST及总胆红素水平与术前差异无统计学意义（P>0.05）。2组患者在整体手术时间和住院时间方面差异无统计学意义（P>0.05）。出院后随访至少6个月，2组患者均未发生复发、出血及梗阻等并发症。

相比专用托肝器械，使用无损伤抓钳托肝的安装时间更短，但对整体手术时间影响不显著，且两种托肝方式均未对肝脏造成严重和长期的损伤，安全性较好。

To evaluate the clinical performance of two liver retraction techniques during laparoscopic hiatal hernia repair.

A total of 36 patients who underwent laparoscopic surgery for hiatal hernia in the Department of General Surgery, Qinghe County Central Hospital, Hebei Province, between December 2022 and December 2024 were retrospectively reviewed. Sixteen patients received liver retraction using an atraumatic grasper inserted via a subxiphoid port (grasper group), and 20 patients received liver retraction using a dedicated liver retractor inserted via a subxiphoid port (retractor group). A retrospective comparison was conducted to determine the effectiveness and safety of the two liver retraction methods in laparoscopic hiatal hernia repair.

All 36 patients successfully completed the procedure. There were no significant between-group differences in sex, age, or body mass index (P>0.05). The liver retractor setup time was significantly shorter in the grasper group than in the retractor group (P<0.05). Between-group comparisons showed no significant differences in serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), or total bilirubin levels preoperatively, on postoperative day 1, or before discharge (all P>0.05). Within-group comparisons indicated that ALT and AST levels on postoperative day 1 were significantly higher than preoperative levels in both groups (P<0.05), whereas total bilirubin on postoperative day 1 did not differ significantly from preoperative values (P>0.05). Before discharge, ALT and AST levels were significantly lower than those on postoperative day 1 (P<0.05), while total bilirubin before discharge did not differ significantly from postoperative day 1 (P>0.05). No significant differences were observed between preoperative values and those before discharge for ALT, AST, or total bilirubin (all P>0.05). There were no significant between- group differences in overall operative time or length of hospital stay (P>0.05). All patients were followed for at least 6 months after discharge, during which no recurrence, bleeding, or obstruction was observed in either group.

Compared with a dedicated liver retractor, liver retraction using an atraumatic grasper requires a shorter setup time, without a significant impact on total operative time. Both techniques appear safe and are not associated with severe or long-term liver injury.