改良手助腹腔镜手术在腹部外科的应用价值  

Application of modified hand-assisted laparoscopic surgery in the abdominal surgery

作　　者：陈应军[1] 甄作均[1] 向青锋[1] 邓斐文[1] 吴志鹏[1] 何尹韬 

机构地区：[1]528000,佛山市第一人民医院肝脏胰腺外科

出　　处：《中华消化外科杂志》2015年第7期574-577,共4页Chinese Journal of Digestive Surgery

基　　金：广东省医学科研基金（A2014697）

摘　　要：目的 探讨改良手助腹腔镜手术（MHALS）在腹部外科应用的安全性和可行性.方法 回顾性分析2014年9月至2015年1月佛山市第一人民医院收治的8例采用长袖套式手助器施行MHALS患者的临床资料.其中右肝癌伴同侧肝内转移2例,左肝癌1例,肝门部神经鞘瘤1例,左腹膜后平滑肌肉瘤1例,肝内外胆管结石1例,胆总管囊肿1例,壶腹部癌1例.利用腹腔镜保护套作为袖套,从开腹切口牵开器中间穿过后,反折保护套包绕牵开器约10 cm.使用时先将牵开器固定在腹壁切口上,袖套远端捆绑固定辅助手的手腕后进行腹腔镜下操作.采用门诊和电话方式进行随访,随访时间截至2015年3月.结果 8例患者均顺利完成MHALS.行原位右半肝切除术1例,门静脉右支结扎＋左半肝离断术1例（术后出现顽固性腹腔积液、胆红素升高而放弃二期手术出院）,肝左外叶切除术1例（术后肝创面出血,予开腹肝创面缝合止血后治愈）,肝门部神经鞘瘤切除术1例,左腹膜后平滑肌肉瘤切除术1例,胆总管切开取石＋左半肝切除＋胆囊切除＋T管引流术1例,胆总管囊肿切除＋胆肠内引流术1例,胰十二指肠切除术1例.4例辅助切口长度为4 cm,4例辅助切口长度为7 cm.8例患者均获得术后随访,中位随访时间为3个月（2～7个月）.行门静脉右支结扎＋左半肝离断术患者术后3个月死亡,其余患者未见肿瘤、结石复发.结论 MHALS在腹部外科应用安全、可行.Objective To investigate the safety and feasibility of modified hand-assisted laparoscopic surgery （MHALS） in the abdominal surgery.Methods The clinical data of 8 patients who underwent long-sleeved MHALS at the First People＆#39;s Hospital of Foshan between September 2014 and January 2015 were retrospectively analyzed.Among the 8 patients,right liver cancer with intrahepatic metastasis was found in 2 patients,left liver cancer in 1 patient,hepatic peripheral nerve sheath tumor in 1 patient,left retroperitoneal leiomyosarcoma in 1 patient,extra-and intra-hepatic cholangiolithiasis in 1 patient,choledochocyst in 1 patient and ampulla cancer in 1 patient.Laparoscopic protection sleeve went through the middle of incision-retractor,and then wrapped around it about 10 cm.Incision-retractor was fixed at the abdominal incision firstly,laparoscopic procedures were performed when the wrist of assisted hand was bound and fixed by the distal of sleeve.The patients were followed up by outpatient examination and telephone interview till March 2015.Results All the 8 patients underwent successful MHALS,including 1 of right hemihepatectomy in situ,1 of ligation of right portal vein ＋ left liver split （the patient gave up two-stage operation due to intractable ascites and elevated bilirubin）,1 of hepatic left lateral lobectomy （the patient underwent hemostatic sutures in open surgery due to hemorrhage of liver＆#39;s cutting surface）,1 of hepatic peripheral nerve sheath tumor resection,1 of left retroperitoneal leiomyosarcoma resection,1 of choledocholithotomy ＋ left hepatectomy ＋ cholecystectomy ＋ T tube drainage,1 of choledochocyst ＋ biliary enteric drainage and 1 of pancreaticoduodenectomy.Four patients had assisted incision of 4 cm,and another 4 patients of 7 cm.Eight patients were followed up for a median time of 3 months （range,2-7 months）.The patient who received ligation of right portal vein ＋ left liver split died at postoperative month 3,and the others didn＇t have recurrence of tumor or l

关 键 词：肝肿瘤 腹部外科手术 腹腔镜检查 手助 

分 类 号：R656[医药卫生—外科学]