基层医院腹腔镜肝切除术后并发症的预防与治疗(附52例报告)  

Prevention and treatment of complications after laparoscopic hepatectomy in primary hospital: with a report of 52 patients

作　　者：韩月锋[1] 李灿[1] 梁志宏[1] 赵象文[1] 刘书强[1] HAN Yue-feng LI Can LIANG Zhi-hong et al(Department of General Surgery,Xiaolan Hospital Affiliated to Southern Medical University, Zhongshan 528415, China)

机构地区：[1]南方医科大学附属小榄医院,广东中山528415

出　　处：《腹腔镜外科杂志》2016年第11期815-819,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨基层医院开展腹腔镜肝切除术的安全性及可行性。方法:回顾分析2010年6月至2014年6月接受腹腔镜肝切除术的52例患者的临床资料,根据改良的Clavien分级系统对术后并发症进行评估。结果:52例患者均顺利完成手术,其中完全腹腔镜肝部分切除术50例,中转开腹行肝部分切除术2例。术后并发症17例为Ⅰ级(术后疼痛14例、术后呕吐3例);12例为Ⅱ级(术后输血6例、肺部感染4例、胆漏2例);1例为Ⅲ级,术后出现应激性急性胃黏膜病变;1例为Ⅳ级,术后出现2型呼吸功能衰竭。无术后膈下积液感染、肝脓肿、肝功能衰竭、肝创面大出血及围手术期死亡等严重并发症发生。结论:有条件的基层医院选择合适的病例开展腹腔镜肝切除术安全、可行,疗效确切,不增加术后主要并发症,值得推广应用。Objective： To explore the practicability and safety of laparoscopic hepatectomy in the primary hospital. Methods： A retrospective analysis was made about the clinical data of 52 patients who underwent laparoscopic hepatectomy from Jun. 2010 to Jun.2014 and the postoperative complications were assessed according to the modified Clavien classification system. Results： All patients were successfully operated. 50 patients received totally laparoscopic partial hepatectomy,and conversion to laparotomy occurred on 2 cases. The postoperative complications of Clavien grade I was diagnosed in 17 cases（ 14 cases of postoperative pain,3 cases of postoperative vomiting）,grade Ⅱ in 12 cases（ 6 cases of postoperative blood transfusion,4 cases of pulmonary infection,2 cases of bile leakage）,grade Ⅲ in 1 case for postoperative irritably acute gastric mucosal lesion,grade IV in 1 case for postoperative type 2 respiratory failure. There was no postoperative subphrenic effusion infection,liver abscess,liver failure,liver wound hemorrhage or perioperative mortality. Conclusions： By selecting the appropriate case,laparoscopic hepatectomy is safe,feasible and effective in qualified primary hospital. It is worthy of applying without increasing the incidence of postoperative major complications.

关 键 词：肝切除术 腹腔镜检查 手术后并发症 

分 类 号：R657.3[医药卫生—外科学]