腹腔镜肝切除术中螺旋水刀的应用  

Application of helix hydro-jet in laparoscopic hepatectomy

作　　者：陈雷[1] 高杰[1] 王福顺[1] 朱继业[1] 冷希圣[1] 

机构地区：[1]北京大学人民医院肝胆外科,100044

出　　处：《中华普通外科杂志》2009年第10期809-812,共4页Chinese Journal of General Surgery

摘　　要：目的评价螺旋水刀在腹腔镜肝切除术中应用的可行性。方法回顾性分析18例行腹腔镜肝切除患者的临床资料。结果本组患者18例，其中肝海绵状血管瘤9例，原发性肝癌5例，肝局灶性结节样增生2例，结肠癌肝转移1例，左肝胆管囊腺瘤1例。本组17例患者行腹腔镜下水刀肝切除术，1例左肝癌患者因术中出血而中转开腹。手术方式为肝部分切除术14例，肝左外叶切除3例。手术时间平均170min。无中转开腹的17例病例术中平均出血量230ml。全组患者无术后出血、肝功能衰竭等严重并发症，有1例患者术后第3天出现少量胆漏，保守治疗后痊愈。2例患者术后出现少量胸腔积液未做特殊处理。术后平均住院5．6d。5例肝癌病例术后平均随访17个月，中转开腹的患者术后13个月肝内其他部位复发，所有切口均未见种植转移。结论腹腔镜下应用螺旋水刀行肝切除时创面清晰，可以保证足够的安全切除边界，术后无严重并发症，是一种安全可行的切肝方法。Objective To evaluate the application of helix hydro-jet in laparoscopie hepatectomy （LH）. Methods Clinical data of 18 patients who underwent laparoscopic hepatectomy by helix hydro-jet were analyzed retrospectively. Results There were 18 cases including 9 cases of hepatic cavernous hemangioma, 5 cases of primary hepatocellular carcinoma, 2 cases of hepatic focal nodular hyperplasia, 1 case of hepatic metastasis from colon carcinoma and 1 case of biliary cystadenoma in left liver. In 17 out of 18 patients laparoscopic hepatectomy was successfully completed by using helix hydro-jet. Only 1 patient was converted to open hepatectomy during operation due to uncontrollable hemorrhage from the branch of left hepatic vein. Partial hepateetomy was performed in 14 cases and hepatic left lateral hepatectomy was performed in 3 cases. Average intraoperative blood loss was 230 ml and average operation time was 170 minutes. No postoperative hemorrhage and hepatic function failure was observed. Postoperative bile leakage was observed in 1 patient, which was cured by drainage. Asymptomatic pleural effusions was found in 2 patients, necessitating no special intervention. The average hospital stay after the surgery was 5.6 days. 5 patients with hepatocellular carcinoma were followed up for an average of 17 months and the patient converted to open hepatectomy suffered from tumor recurrence 13 month postoperatively. No implantation metastasis was observed on the troear sites. Conclusions Laparoscopic hepatectomy by helix hydro-jet device can provide excellent visualization of vessels and bile ducts, which can assure the safe margin of hepatic neoplasm. No severe complications were observed. Laparoscopic hepatectomy by helix hydro-jet is a safe and feasible technique.

关 键 词：肝肿瘤 肝切除术 腹腔镜 螺旋水刀 

分 类 号：R686[医药卫生—骨科学]