腹腔镜超声技术在腹腔镜肝切除术患者中的应用  

Laparoscopic ultrasonography in laparoscopic hepatectomy： experience with 22 cases

作　　者：朱玲华[1] 蔡秀军[1] 梁霄[1] 虞洪[1] 徐海珊 王一帆[1] 王知非[1] 彭淑牖[1] 

机构地区：[1]浙江大学微创外科研究所、浙江大学医学院附属邵逸夫医院普外科,杭州310016 [2]邵逸夫医院超声科

出　　处：《中华医学杂志》2008年第15期1059-1061,共3页National Medical Journal of China

基　　金：浙江省科技厅基金资助项目（200303055）

摘　　要：目的探讨腹腔镜超声肝脏检查及在其引导下施行腹腔镜肝切除术的价值。方法22例腹腔镜肝切除术中应用10mm7．5／10MHz线性超声探头检查肝脏，在腹腔镜和超声波共同引导下，了解切线上肝内管道分布和走行，确定并校正切线，引导腹腔镜肝切除，并了解肿瘤边缘或结石残留情况。结果应用腹腔镜超声的22例腹腔镜肝切除术中发现1例肝脏意外肿瘤灶1个，21例手术获得成功，其中1例由于肝硬化肝创面出血中转开腹手术。手术时间平均为157min，腹腔镜超声检查和引导时间平均14min，术中平均出血量为520ml。无结石或肿瘤残留。术后出现肝创面胆漏和膈下积液各1例，均经引流后痊愈。结论腹腔镜超声检查能较准确对腹腔镜肝切除术前后进行评估，在其引导下有助于腹腔镜肝切除术的顺利施行。Objective To assess the value of laparoscopic ultrasonography in laparoscopic hepatectomy. Methods Twenty-two patients with liver diseases underwent laperoscopic ultrasonography. A 10 nun 7. 5/10 MHz linear, side viewing laperoscopic ultrasonography probe was used intra-operatively to examine the convergence of intrahepatic biliary ducts and blood vessels, confirm and correct the resection line, guide the laparoscopic resection, examine the tumor margin, and discover the residue of calculi. Results One additional tumor was detected in one primary liver tumor case during the laparoscopic hepatectomy. Laparoscopic hepatectomy was accomplished successfully in 21 patients one of which had to be transferred to laporotomy due to severe liver cirrhosis and uncontrollable bleeding. The average operation time was 157 min with the average examining and guiding time of 14 min The intra-operative bleeding amount was 520 ml. No calculus and tumor residue were found. One case of post-operative liver wound bile leakage and one case of subphrenic hydrops were found and they both recovered after drainage. Condusion Intra-operative laparoscopic ultrasonography helps evaluate the entire liver and decide the resection line accurately. Under its guiding the laparoscopic hepatectomy can be performed smoothly.

关 键 词：腔内超声检查 肝 腹腔镜 外科手术 

分 类 号：R686[医药卫生—骨科学]