腹腔镜肝脏切除术29例报告  

Experience of 29 cases of laparoscopic hepatectomy

作　　者：祁玉波[1] 

机构地区：[1]南通大学附属建湖医院,江苏盐城224700

出　　处：《腹腔镜外科杂志》2015年第3期201-204,共4页Journal of Laparoscopic Surgery

摘　　要：目的：总结腹腔镜肝脏切除术的临床疗效及手术经验。方法：回顾分析2012年6月至2014年6月为29例患者行腹腔镜肝脏切除术的临床资料,其中男17例,女12例,31-65岁,原发性肝癌15例,肝血管瘤8例,结直肠转移性肝癌3例,肝内胆管结石2例,肝局灶结节性增生1例。结果：12例行腹腔镜左肝外叶切除术,4例行左半肝切除术,病变局部不规则性切除术11例,两个以上部位联合切除2例。手术时间平均（111.0±42.2）min,手术出血量平均（133.1±196.9）ml,术后平均住院（6.2±1.6）d。全组无围手术期死亡。3例术后发生并发症,包括肺部感染2例、胆漏1例。无术后腹水、肝功能衰竭发生。3例原发性肝癌、1例结直肠转移性肝癌患者于术后1年复发,经后续射频消融、导管动脉内化疗栓塞治疗后生存至今。肝脏良性疾病术后均得到良好恢复。结论：把握手术适应证,具备良好的团队协作,腹腔镜肝切除术具有安全性好、并发症少、术后康复快等优点,可安全有效地治疗肝脏良恶性疾病。Objective： The aim of this study was to summarize the clinical therapeutic effect and operative experience of laparoscopic hepatectomy. Methods： Twenty-nine patients who underwent laparoscopic hepatectomy from Jun. 2012 to Jun. 2014 were identified in a retrospectively collected database. The demographic data and operative outcomes of these patients were reviewed. They were 17 males and 12 females,and the age ranged from 31 to 65 years old. The final histological diagnoses were as follows： primary hepatic carcinoma（ n = 15）,hepatic hemangioma（ n = 8）,colorectal livermetastases（ n = 3）,hepatolithiasis（ n = 2）,hepatic focal nodular hyperplasia（ n = 1）. Results： The laparoscopic operations included left lateral lobectomy（ n = 12）,left hemihepatectomy（ n = 4）,local resection（ n = 11） and combined resection（ n = 2）. The mean operation time,blood loss,length of hospital stay were（ 111. 0 ±42. 2） min,（ 133. 1 ± 196. 9） ml and（ 6. 2 ± 1. 6） d respectively. No perioperative death was found. 2 patients with pulmonary infection and 1 patient with bile leakage were diagnosed after operation. There was no postoperative ascites or hepatic failure. 3 cases with primary hepatic carcinoma and 1 case with colorectal livermetastases experienced relapses in 1 year after initial treatment and have been living after treatments of radiofrequency ablation and transarterial chemoembolization. Patients with hepatic benign diseases had a remarkable recovery after laparoscopic liver resection. Conclusions： As a kind of mini-invasive surgical operation,laparoscopic liver resection is a safe,feasible and effective procedure for the treatment of benign liver diseases and malignant liver neoplasms as long as the patients are properly selected. With excellent teamwork,this procedure has advantages of few complications and quick recovery.

关 键 词：肝切除术 腹腔镜检查 

分 类 号：R657.3[医药卫生—外科学]