腹腔镜肝切除术的初步经验  

Laparoscopy for Liver resection

作　　者：郑树国[1] 李建伟[1] 李剑斌[1] 冯晓彬[1] 王曙光[1] 别平[1] 

机构地区：[1]第三军医大学西南医院全军肝胆外科研究所、中国人民解放军西南肝胆外科医院,重庆400038

出　　处：《中华消化外科杂志》2007年第6期424-427,共4页Chinese Journal of Digestive Surgery

摘　　要：目的 总结腹腔镜肝切除术的技术要点和效果。方法 回顾分析本中心2007年3月1Et至2007年6月30Et21例腹腔镜肝切除术患者的临床资料。结果 21例中2例中转开腹，1例改为手助式腹腔镜肝切除，其余18例在全腹腔镜下完成肝切除术。规则性肝叶（段）切除15例，其中左半肝切除5例，左外叶切除6例（其中1例联合右肝肿瘤射频消融术），Ⅵ段切除4例；不规则切除6例。7例在区域性半肝血流阻断条件下手术，3例行间歇性第一肝门血流阻断，11例未行人肝血流阻断；平均手术时间为185min，平均出血量320ml，术后恢复顺利，全组无手术死亡及并发症发生，平均住院时间为9d。随访2-6月，除1例多发性肝细胞癌患者术后40d出现再发肿瘤外，其余恶性肿瘤患者无复发，良性病变患者无症状再发。结论腹腔镜肝切除术是值得选择的微创方式，其技术要点是选择恰当的手术人路，有效控制人肝血流，其中选择性半肝血流阻断技术的应用和肝断面的妥善处理是确保手术成功和减少手术并发症的关键。Objective To review techniques and outcome of laparoscopic liver resection. Methods A retrospective analysis was done based on the clinical data of 21 patients undergone laparoscopic liver resection from March 1 to June 30, 2007. Results Eighteen patients received successful total laparoscopic liver resection, 2 were converted to laparotomy and 1 to hand - assisted laparoscopic liver resection. Anatomical liver resection was carried out on 15 patients including 5 with left hemibepatectomy, 6 with left lateral segmentectomy （1 combined with radiofrequency ablation for the tumor in the right liver lobe） , and 4 with segment VI resection; 6 patients un- derwent nonanatomical bepatectomy. The liver parenchymas of 7 patients were transected under regional bemi-hepatic blood occlusion, 3 under intermittent Pringle＇s manoeuvre, and 11 without hepatic blood inflow occlusion. The mean operation time was 185 minutes （range 50-358 minutes） , mean blood loss 320 ml （range 20-1300 ml）, and mean hospital stay 9 days （range 5-16 days）. No operative death and postoperative complications occurred, and the patients recovered well. All the patients were followed up for 2-6 months, no recurrence was found in patients with benign malignant liver tumor except 1 with multiple bepatocellular carcinoma 40 day after operation. Conclusions The key points of laparoscopic liver resection are right choice of surgical approach and effective control of hepatic blood inflow. The application of selective bemi-bepatic blood occlusion technique and proper management of cutting surface of liver are important in ensuring the success of operation and reduction of complications.

关 键 词：腹腔镜 肝切除术 

分 类 号：R686[医药卫生—骨科学]