腹腔镜肝切除术中肝静脉阻断可行性分析  

Application of controlling hepatic vein in laparoscopic hepatectomy

作　　者：晏益核[1] 卢榜裕[1] 蔡小勇[1] 黄玉斌[1] 靳小建[1] 李建军[1] 

机构地区：[1]广西医科大学第一附属医院微创外科,广西南宁530021

出　　处：《中国实用外科杂志》2013年第3期208-210,共3页Chinese Journal of Practical Surgery

基　　金：广西高等学校科研项目(201204LX056);广西卫生厅科研项目(Z2012100)

摘　　要：目的探讨腹腔镜肝切除术离断肝实质前阻断肝静脉的可行性。方法回顾性分析2007年5月至2012年4月广西医科大学第一附属医院微创外科在腹腔镜肝切除术断肝前阻断肝静脉15例临床资料。结果5例左外肝叶切除，8例左叶肝切除，1例右叶肝切除，1例血管瘤切除。7例在肝膈面缝扎肝左静脉，6例在肝实质外分离肝左静脉，2例分离肝右静脉。平均手术时间（261．0±79．5）min，术中出血（403．3±259．4）mL，输浓缩红细胞（1．1±2．0）U，血浆（66．7±144．8）mL，住院时间（14．0±3．1）d。术后腹腔出血1例，腹水1例。随访时间4—59个月，复发时间3～14个月，复发率54％，存活率57％。结论腹腔镜肝切除术中在肝实质外分离肝静脉是可行的，而且有解剖路径可以依据。Objective To study the clinical application and anatomical approach of controlling hepatic vein extraparenchymally before transection in laparoscopic hepatectomy. Methods The clinical data of 15 patients performed controlling hepatic outflow extraparenchymally before transection in laparoscopie hepatectomy between May 2007 and April 2012 in Department of Minimally Invasive Surgery, First Affiliated Hospital of Guangxi Medical University were analyzed retrospectively. Results Controlling hepatic vein extraparenchymally before transection was successfully finished in 15 patients. The operation included left lateral seetionectomy in 5 patients, left hepatectomy in 8 patients, right hepatectomy in 1 patient and hemangioma resection in 1 patient. Pre-parenchymal transection control of hepatic vein was performed in 15 patients, which included the left hepatic vein was controlled by suturing or separating in 13 patients and right hepatic vein was controlled by separating in 2 patients. The mean operative time was （261.0± 79.5） rains. The mean blood loss during operation was （403.3 ± 259.4）mL. Concentrated red blood cells transfusion volume was （1.1±2.0）U,and plasma transfusion volume was （66.7±144.8）mL. The mean hospitalization time was（14.0± 3.1 ） days. The complications included postoperative bleeding in 1 patient and aseites in 1 patient. The follow-up ranged from 4 to 59 months. The recurrence was occurred during 3-14 months after operation. The recurrence rate was 54% and the survival rate was 57%. Conclusion Controlling hepatic vein extraparenchymally before transection in laparoseopic hepatectomy follows the anatomical approach, which is safe and reliable.

关 键 词：腹腔镜 肝切除 肝静脉 血流阻断 

分 类 号：R6[医药卫生—外科学]