小儿腹腔镜下肝切除术4例  

Laparoscopic liver resection in children： a report of 4 cases.

作　　者：段怡涛[1] 郑百俊[1] 高亚[1] 王怀杰[1] 黄强[1] 潘伟康[1] 郭新奎[1] 郭正团[1] 龚伟[1] 李鹏[1] 吴宣林[1] 

机构地区：[1]西安交通大学第二附属医院儿童病院外科陕西省,西安市710004

出　　处：《临床小儿外科杂志》2013年第2期110-112,119,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的报告4例小儿腹腔镜肝切除术的临床经验。方法采用4—5mm套管，腹压10—12mmHg。解剖性肝左叶切除在肝外游离结扎肝左动脉和门静脉左支。超声刀离断浅部肝实质，深部用CUSA解剖出管道、Ligasure凝切，线型Endovascular离断肝静脉。非规则性肝切除不阻断或解剖肝门。切除标本套袋后经扩大的脐部或下腹部Trocar切口取出。结果男女各2例，年龄3个月至4岁，手术时间100～340min，出血量20一200mL。无术中术后并发症。肝肉芽肿患儿随访6年未发现其他部位肉芽肿，肝血管瘤随访5个月无症状。2例肝母细胞瘤患儿中，1例正在化疗中，另1例采取观察随访。结论选择合适病例，小儿腹腔镜肝切除术安全可行。Objetive Laparoscopy for the resection of liver masses in children has remained undevel- oped despite the wide acceptance of laparoscopy in the field of adult liver surgery. The authors report 4 cases of nonanatomical or anatomical laparoscopic hepatic resection of ＇children. Methods Four to five trocars were placed. Pneumoperitoneum was established and maintained at 10 - 12 mmHg during tumor resection. For ana- tomical left hepatectomy the extra-hepatic artery, potal vein was isolated and ligated. The superior liver paren- chyma was then dissected by using Harmonic scalpel. Moderate vessel was dissected by an ultrasonic dissector and sealed by the LigaSure （Valley lab）. Finally the linear Endo-GIA was used to staple off the specimen from the hepatic vein. The specimen was removed by an extended umbilical/port incision or a small Pfannenstiel in- cision. Results There were 2boys and 2 girls with an age range from 3 months to 4 years old. Operative＇time was between 100 minute and 340 minute with bleeding of 20- 200 mL. No peri-operative complication was ob- served. The patients have been followed up for 3 months to 6 years and have remained asymptomatic since surgery. Conclusions These cases demonstrate the feasibility of laparoseopic hepatic resection, even for bal- king large tumors, employing standard principles of liver surgery and safety.

关 键 词：腹腔镜 肝切除术 儿童 

分 类 号：R657.3[医药卫生—外科学]