手助腹腔镜切除左肝巨大肿瘤九例  

Hand-assisted laparoscopic hepatectomy for left hepatoma

作　　者：张绍庚[1] 陈永标[1] 詹晓静[1] 高远[1] 魏炜明[1] 

机构地区：[1]南京军区福州总医院肝胆外科,福州350025

出　　处：《中华普通外科杂志》2007年第12期884-887,共4页Chinese Journal of General Surgery

摘　　要：目的探讨手助腹腔镜左肝巨大肝肿瘤切除的可行性和安全性。方法本组9例患者,平均年龄45.3岁,肿瘤均位于左肝,包括肝细胞癌(4例),肝内胆管细胞癌(1例),肝转移性鳞癌(1例),肝海绵状血管瘤(2例),肝梭形细胞瘤(1例)。AFP 阳性3例,CEA 阳性1例,术前肝功能均为 Child-Pugh A 级,手术按游离左肝韧带、阻断肝门和肝实质切除的步骤进行。结果 9例手助腹腔镜肝切除均获得成功,肝左外叶切除6例,左半肝切除3例,无中转开腹。平均手术时间为111.7 min,平均出血量97.8 ml,8例行肝门阻断,平均阻断时间为13.4 min。术中未发生大出血和气体栓塞,术后均无出血、胆漏和肝衰竭等严重并发症发生。肝功能均在7～10 d 恢复正常。AFP 和CEA 阳性者均转阴,术后平均住院日为8.4 d。4例肝细胞癌术后1个月行预防性肝动脉造影和化疗1次。术后随访4～11个月,所有患者均无瘤生存。结论只要病例选择得当,手助腹腔镜左肝巨大肝肿瘤切除是安全可行的微创手术方式。Objective To study the feasibility and safety of hand-assisted laparoscopic hepatectomy for huge left hepatoma. Methods Nine patients with huge left hepatoma underwent handassisted laparoscopic hepatectomy including hepatocellular carcinoma （ 4 cases ）, intrahepatic cholangiocarcinoma （1 case）, hepatic metastatic squamous carcinoma （1 case ）, hepatic cavernous hemangioma （2 cases） , and hepatic spindle cell tumor （ 1 case）. The mean age was 45.3 years. AFP was positive in 3 cases and CEA was positive in 1 case. The preoperative liver function was Child-Pugh A in all patients. The procedure included dissection of left hepatic ligaments and portal triad clamping with Pringle＇s maneuver and hepatectomy. Results The laparoscopic procedures were completed safely in all patients including 6 left lateral segrnentectomies and 3 left hemihepatectomies. There was no conversion to laparotomy. Mean surgical time was 111.7 minutes. Mean blood loss was 97. 8 ml. Portal triad clamping was used in 8 cases and mean clamping time was 13.4 minutes. Neither formidable bleeding nor gas embolism occurred. There were no serious postoperative complications such as postoperative bleeding or bile leak or liver failure. Liver function recovered within 7 to 10 days. Preoperatively positive AFP and CEA turned negative after operation. The mean postoperative hospital stay was 8.4 days. Four patients with HCC underwent postoperative prophylactic hepatic arterial chemoembolization within the first postoperative month. All patients were tumor-free as evaluated by postoperative follow-up of 4 - 11 months. Conclusions Hand-assisted laparoscopic hepatectomy for huge left hepatoma is feasible and safe in appropriately selected patients.

关 键 词：肝肿瘤 肝切除术 手助腹腔镜手术 

分 类 号：R735.7[医药卫生—肿瘤]