腹腔镜肝切除术治疗肝细胞癌37例临床分析  

Laparoscopic liver resection for hepatocellular carcinoma of 37 cases

作　　者：张志波[1] 郑树国[1] 李建伟[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、西南肝胆外科医院,重庆400038

出　　处：《中华普通外科杂志》2009年第10期806-808,共3页Chinese Journal of General Surgery

摘　　要：目的探讨腹腔镜肝切除术治疗合并乙型肝炎后肝硬化的肝细胞癌的技术要点和近期疗效。方法2007年3月1日至2008年9月30日西南医院对37例合并乙型肝炎后肝硬化的肝细胞癌患者施行腹腔镜肝切除术。结果37例患者中32例完成全腹腔镜肝切除术，3例完成手助式腹腔镜肝切除术，2例中转开腹。解剖性肝切除23例，包括左半肝切除4例，左外叶切除8例，超左半肝切除1例，右半肝切除2例，单肝段切除8例；非解剖性肝切除术14例，其中10例在区域性半肝血流阻断条件下手术。本组患者平均手术时间212min，平均术中出血量354ml。全组无1例手术死亡，术后出现腹水和胸腔积液3例、肝断面包裹性积液2例、腹腔内出血1例。术后1～2d下床活动，5—7d肝功恢复正常，平均术后住院时间8d。随访2～21个月，3例出现肝内非原位复发，其中1例术后8个月死亡，2例带瘤生存至今。结论腹腔镜肝切除术治疗合并乙型肝炎后肝硬化的肝细胞癌安全可行。技术要点是根据病变大小、部位及肝硬化程度选择不同的肝切除方式及肝血流阻断方式，肝实质离断过程中联合使用以超声刀为主的多种器材，妥善处理肝断面。Objective To study the key technology and initial results of laparoscopic liver resection for hepatocellular carcinoma （HCC） with B posthepatitic cirrhosis. Methods From March 2007 to September 2008, 37 HCC patients with posthepatitic cirrhosis were treated with laparoscopic liver resection in our hospital. Results Thirty-two patients received successful total laparoscopic liver resection, 3 handassisted laparoscopic Fiver resection, and 2 were converted to open surgery. Anatomic liver resection was performed in 23 patients including 4 left hepatectomy, 8 left lateral segmentectomy, 1 extended left hepatectomy, 2 right hepatectomy, 8 segmentectomy. Fourteen patients underwent nonauatomic liver resection. Liver parenchyma was transected under regional hemi-hepatic blood occlusion in 10 patients, under intermittent Pringle＇s manoeuvre in 15 cases, and without hepatic blood inflow blockage in 12 cases. The mean operative duration was 212 rain （76 - 435 min） and mean blood loss 354 ml （ 100 - 1300 ml ）. Mortality rate was 0%. Six patients developed 9 postoperative complications including intraabdominal hemorrhage in 1 case, ascites and hydrothorax in 3 and encapsulated effusion of liver section in 2. The mean postoperative hospital stay was 8 d （4 - 15 d）. In a follow-up from 2 to 21 months, 3 patients developed intrahepatic tumor recurrence. One or the 3 patients died 6 months after reoperation, and the other 2 received chemoembolization and radiofrequency ablation, respectively. Conclusion Laparoscopic liver resection for HCC with posthepatitic cirrhosis in selected patients is a safe procedure with oncologic efficiency. Its advantages include reduced invasiveness, quick rehabilitation, few postoperative complications and short hospital stay.

关 键 词：癌 肝细胞 腹腔镜 肝切除术 肝硬化 

分 类 号：R686[医药卫生—骨科学]