完全腹腔镜肝切除64例手术经验  

Clinical experience of 64 cases of laparoscopic hepatectomy

作　　者：宗科[1] 杨斌[1] 喻凯[1] 钱贤忠[1] 吴晓康[1] 吴荣进[1] 毛根军[1] 

机构地区：[1]金华市中心医院,浙江金华321000

出　　处：《腹腔镜外科杂志》2015年第5期331-334,共4页Journal of Laparoscopic Surgery

基　　金：浙江省医药卫生科技计划项目(编号:2014ZDA028)

摘　　要：目的:探讨完全腹腔镜肝切除术的临床应用体会。方法:回顾分析2012年7月至2014年12月收治的64例完全腹腔镜肝切除术患者的临床资料。根据病变部位所在肝段,结合术前影像学等检查,评估与重要血管的毗邻关系,采用前入路技术路线或右侧入路技术路线,用超声刀或能量平台游离肝周韧带,显露肝门。结果:62例成功完成腹腔镜肝切除术,2例中转开腹,1例因肝血管瘤包膜破裂出血难以控制而中转开腹;1例因大血管出血,镜下显露困难,难以止血而中转开腹。49例行局部切除术,15例行肝脏规则性切除术。手术时间平均(191.0±17.6)min;手术出血量平均(610.4±51.4)ml;自体血回输31例,输入自体血平均(520.1±43.7)ml,外源性输血23例,输血量平均(580.5±46.4)ml。无其他严重并发症发生。术后患者恢复情况可,顺利出院。结论:腹腔镜肝切除术是安全、可行的,值得推广应用。Objective： To explore the clinical application of totally laparoscopic hepatectomy. Methods： Clinical data of 64 pa- tients who underwent totally laparoscopic hepatectomy from Jul. 2012 to Dec. 2014 were retrospectively analyzed. According to the he- patic segment where lesion located, surgeons evaluated the relationship between the lesions and important blood vessels combined with preoperative imaging examination. Technical route of anterior approach or right approach was used. Peripheral hepatic ligaments were separated using ultrasound knife or energy platform to expose porta hepatis. Results：Sixty-two cases of laparoscopic hepatectomy were successful,2 cases were converted to open surgery, including 1 case with hepatic hemangioma capsule rupture,it was difficult to control the hemorrhage, 1 case because of large vascular hemorrhage, endoscopic exposure and hemostasis was difficult. 49 cases of local resec- tion and 15 cases of hepatic lobectomy were performed. The operation time was （191.0 ± 17.6） min; intraoperative blood loss was （610.4 ±51.4） ml ; autologous blood transfusion occurred in 31 cases, the input volume of autologous blood was （520.1 ± 43.7 ） ml, exogenous blood transfusion occurred in 23 cases, the input volume was （580.5 ±46.4） nil. No other serious complications were found. Patients recovered well and were discharged from hospital. Conclusions：The totally laparoscopie hepatectomy is safe and feasible, is worth popularization and application in clinic.

关 键 词：肝切除术 腹腔镜检查 并发症 安全性 

分 类 号：R735.7[医药卫生—肿瘤]