一种腹腔镜标准术式的探索:模式化腹腔镜左半肝切除术  

Stylized laparoscopic left hemihepatectomy:consideration as a standard laparoscopic procedure

作　　者：王雪飞 胡明根[2] 赵国栋[2] 许勇[2] 许大彬[2] 薛瑞华[2] 刘荣[2] 

机构地区：[1]解放军医学院研究生队,北京100853 [2]解放军总医院肿瘤外二科

出　　处：《中华腔镜外科杂志（电子版）》2014年第3期1-5,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的：总结阐述本中心肝脏微创外科手术经验-模式化完全腹腔镜下左半肝切除术，并评估其在治疗肝脏良、恶性疾病中的应用价值。方法回顾性分析自2002年1月至2012年1月接受腹腔镜肝脏手术的患者的临床资料，根据不同的手术操作方式分为三组：早期开展的腹腔镜左半肝切除术组（early laparoscopic left hemihepatectomy，ELLH）、模式化腹腔镜左半肝切除术组（stylized laparoscopic left hemihepatectomy，SLLH），腹腔镜肝左外叶切除术组（laparoscopic left lateral sectionectomy，LLLS），对各组之间的手术时间、术中失血量、住院时间、术后并发症等临床数据并进行统计分析。结果完全腹腔镜左半肝切除术72例（早期开展的腹腔镜左半肝切除术26例，模式化腹腔镜左半肝切除术46例），完全腹腔镜左外叶切除术95例。 SLLH 组中位手术时间182 min（范围：120-360 min）、中位失血量150 ml（范围50-1600 ml）、中位住院时间5 d（范围3-12 d，）均低于 ELLH 组（182 min VS.232.5 min，P〈0.01；150 ml VS.300 ml，P〈0.01；5 d VS.7 d，P〈0.05）。SLLH 组中位手术时间长于 LLLS 组（182 min VS 115.5 min，P〈0.01），失血量与住院时间两组之间无统计学差异（P＞0.05）。结论模式化腹腔镜左半肝切除术是以“一阻二切”方法处理入肝血流、超声刀结合双极电凝离断肝脏实质为核心技术的手术方式，该术式化繁为简，可安全有效的应用于肝脏良、恶性疾病的手术治疗。Objective To illustrate a new laparoscopic surgical technique： stylized laparoscopic left hemihepatectomy and evaluate the safety and efficacy in the treatment of benign and malignant liver disease. Methods A retrospective analysis of a database of all patients who underwent laparoscopic liver procedures between 2002 and 2012 was conducted. Patients were divided into 3 groups： early laparoscopic left hemihepatectomy （ELLH）,stylized laparoscopic left hemihepatectomy （SLLH） and laparoscopic left lateral sectionectomy （LLLS）. Data of various forms of surgical procedures were recorded, analyzed and compared. Results A total of 72 laparoscopic let hemihepatectomy and 95 laparoscopic left lateral sectionectomy were identified （include 26 ELLH and 46 SLLH）. The SLLH group had a shorter median operation time, median length of hospital stay and lower median blood loss compared with ELLH group respectively（182 min VS. 232.5 min,P〈0.01;150ml VS. 300ml,P〈 0.01;5 d VS. 7 d,P〈 0.05）. The median＆amp;nbsp;operation time of ELLH group was longer than the LLLS group（182 min VS. 115.5 min,P〈 0.01）, but length of hospital stay and blood loss had no statistical difference between two groups.Conclusions Stylized laparoscopic left hemihepatectomy in which the left pedicle is isolated, clamped extraparenchymally and transected intraparenchamally, liver parenchymal transection is performed by using harmonic scalpel combined with bipolar vessel sealing device is practicable, safe and effective.

关 键 词：腹腔镜 肝切除术 微创外科 肝脏肿瘤 

分 类 号：R735.7[医药卫生—肿瘤]