完全腹腔镜肝部分切除术临床体会  

Clinical experiences of total laparoscopic partial liver resection

作　　者：陈钟[1] 陈二林[1] 唐伟东[1] 常仁安[1] 朱李瑢[1] 

机构地区：[1]南通大学附属医院肝胆外科,江苏南通226001

出　　处：《中华腔镜外科杂志（电子版）》2014年第1期26-30,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：江苏省"科教兴卫工程"医学领军人才和创新团队项目(LJ201134);江苏省"青蓝工程"创新团队培养对象项目(苏教师[2010]27号)

摘　　要：目的总结20例完全腹腔镜肝切除术手术经验，阐述其技术要点和效果。方法回顾性分析2011年4月至2013年11月间我院20例完全腹腔镜肝切除术患者的临床资料。其中肝左叶部分切除15例，肝右叶部分切除5例。术前应用肝功能Child分级、ICGR15评估肝储备功能及cT三维成像评估肝肿瘤周围血管情况，术中根据肝脏病灶部位选择手术径路，应用超声刀、钛夹、LigaSure、Endo—GIA等多种断肝方法行完全腹腔镜肝部分切除。结果20例患者均成功施行完全腹腔镜下肝部分切除术，手术时间105—215min，出血量50～500ml，术中未出现严重并发症，术后均顺利恢复，术后平均住院日为7．5d。除2例原发性肝癌患者分别于术后随访5个月、12个月发现肿瘤复发外，其余原发性肝癌患者尚未见复发，良性病变患者无症状再发。结论术前进行肝功能及影像学评估、术中选择合适的手术入路及灵活应用各种断肝器械是成功施行完全腹腔镜肝部分切除术的保证。Objective To summarize the experience of 20 cases of total laparoscopic partial liver resection and introduce the surgical technique. Methods From April 2011 to November 2013, 20 cases of laparoscopic partial liver resection in our hospital were analyzed retrospectively, including 15 cases of partial left liver resection and 5 cases of partial right liver resection. Using liver function Child classification and ICG R15 to evaluate hepatic functional reserve preoperatively and three-dimensional CT imaging to assess the anatomical structure surrounding liver tumor such as blood vessels, intraoperative surgical approach is selected according to the liver lesion site and using ultrasonic knives, clip, LigaSure, Endo- GIA and other laparoscopic equipments to dissection liver and complete partial hepatectomy. Results Totally laparoscopic partial liver resection were carried successfully on 20 cases, with operative time between 105 to 215 min,blood loss between 50 to 500 ml. All patients recovered from the operation successfully with no complications. The average hospital stay postoperation was 7.5 days. Except two cases of primary liver cancer patients were found recurrence about 5 months follow-up and 12 months follow-upafter operation, the rest has been found no evidence of tumor recurrence as yet. Conclusion Preoperative assessment of liver function and CT imaging, intraoperative selecting the appropriate surgical approach and flexible application of the various instruments are the essential for successful completion of laparoscopic partial hepatectomy.

关 键 词：腹腔镜 肝部分切除术 

分 类 号：R735.7[医药卫生—肿瘤]