经胸腔内镜下肝癌切除三例  

Thoracoscopic hepatectomy for hepatic carcinoma in 3 cases

作　　者：蒋斌[1] 修典荣[1] 沈祯云[2] 马朝来[1] 原春辉[1] 李磊[1] 孙涛[1] 王行雁[1] 

机构地区：[1]北京大学第三医院普外科,100191 [2]北京大学第三医院胸外科,100191

出　　处：《中华普通外科杂志》2012年第10期808-811,共4页Chinese Journal of General Surgery

摘　　要：目的探讨经胸腔内镜下肝脏肿瘤切除的可行性、安全性和疗效。方法2007—2011年，北京大学第三医院完成3例经胸腔内镜下肝脏单发肿瘤切除术。其中1例为原发性肝癌，2例为肝脏转移癌。术前通过影像检查对肿物进行三维定位，以确定术中套管的位置。患者置于左侧卧位，在肿瘤周围的胸壁放置3个套管。内镜超声确认肿物位置后打开膈肌，在肝脏表面内镜超声再次明确肿物边界并标记切除线。依照标记逐步切开肝脏组织，切除过程中反复行内镜超声确认肿瘤位置和切除深度，以保证肿瘤的完整切除。创面止血满意后关闭膈肌，放置胸腔引流。结果3例患者均顺利完成手术，手术时间110～210min，平均150min，术中出血量130—600ml，平均297ml。术后患者恢复顺利，无并发症。术后分别随访9—42个月，1例死于其他疾病，所有患者均无肿瘤复发。结论对于特定的病例，经胸腔内镜下肝脏肿瘤切除术安全、可行，在术后并发症、住院时间等方面有明显的优势。Objective To study the safety, feasibility and efficacy of thoracoscopichepatectomy for liver carcinoma. Methods Thoracoscopic hepatectomy was performed in 3 cases with single liver neoplasm from 2007 to 2011, including hepatocellular carcinoma （ HCC ） in one case and metastatic liver cancer in 2 cases. By preoperative imaging the tumor was located accurately to simulate the port position in operation. Patients were placed in a left lateral decubitus position, and 3 ports were inserted into the chest wall surrounding the tumor. Through the use of intra-operative thoracoscopic ultrasonography （IOTU）, the diaphragm just above the tumor was opened. IOTU was performed on the liver surface and the resection line was marked. Throughout the course of parenchymal transection, IOTU was performed repeatedly to guide the resection line, and ensure the complete removal of the tumor. After meticulous hemostasis of the resection surface, the diaphragm was closed. A thoracic drain was left. Results Thoracoscopic hepatectomy succeeded in all 3 cases, the median total operating time was 150 min （110 -210 min）, and the median blood loss was 297 ml （130 -600 ml）. Patients recovered quickly and had no major post-operative complications. During 9 to 42 months＇ follow-up, one patients died of other cause, no relapse of the diseases was found. Conclusions Thoracoscopic hepatectomy is a safe and feasible operation in selected patients and has advantages in post-operative morbidity and in hospital time.

关 键 词：肝肿瘤 肝切除术 胸腔镜 

分 类 号：R735.7[医药卫生—肿瘤]