单中心腹腔镜下肝癌肝切除术457例分析  

Laparoscopic Liver Resection for Liver Cancer,Report of 457 Cases of a Single Center

作　　者：柴松山 王健[1] 项帅 朱鹏 张必翔[1] 陈孝平 张万广[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院肝脏外科中心,武汉430030

出　　处：《中华普外科手术学杂志（电子版）》2017年第5期376-379,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：卫生部属医院临床重点项目(NO439-512010);国家十二五科技重大专项(2012X10002016-004)~~

摘　　要：目的探讨腹腔镜肝癌肝切除术的切除方式、血流阻断技术应用及临床疗效。方法回顾性分析自2002年1月至2016年12月457例接受腹腔镜肝癌肝切除术病人的临床资料,并予以评价分析。利用软件SPSS 22.0版本进行分析。手术时间、术中出血量采用均数±标准差表示,t检验;术后并发症及其他指标采用频数及%表示,χ2检验。P<0.05差异具有统计学意义。结果 15年间共行腹腔镜肝癌肝切除457例,其中解剖性肝切除术183例,切除范围:单肝段15例(8.2%),两肝段112例(61.2%)和大范围肝切除56例(30.6%)。腹腔镜下肝切除采用悬吊法有15例;单用Pringle手法167例;选择性入肝血流阻断65例,其中不解剖肝门的入肝血流阻断10例;Pringle手法联合肝下下腔静脉阻断80例。该组病例总的手术时间为(270.7±91.4)min,术中出血量为(413.2±257.5)ml,中转开腹手术41例。术后并发症发生率为27.8%,术后3个月内死亡率0.65%,术后平均住院时间(7.2±3.1)d。结论腹腔镜肝癌肝切除术在临床已经广泛开展,各类血流阻断技术安全有效的应用到术中出血的控制,并且对大范围和肝段肝切除亦切实可行。Objective To explore the surgical treatment, hepatic vascular exclusion techniques and clinical outcome of laparoscopic hepatectomy for liver cancer. Methods From January 2002 to January 2016, 457 patients who underwent laparoscopic hepatectomy for liver cancer were enrolled.Clinical data were analyzed by using statistical software SPSS 22.0.Measurement data such as operation time and intraoperative blood loss were expressed as mean ±standard deviation（-x ±s）, and were examined by using t test.Count data, such as postoperative complication rate, were expressed as %, and were examined by using χ2 test.A P value 〈0.05 was considered as statistically significant difference. Results 457 cases received laparoscopic hepatectomy during 15 years.There were 183 cases of anatomical hepatectomy, including 15 cases of segmentectomy （8.2%）, 112 cases of bisegmentectomy （61.2%） and 56 cases of major resection （30.6%）.There were 15 cases of laparoscopic hepatectomy by using hanging maneuver, 167 cases by using Pringle maneuver, 65 cases by using selective hepatic vascular exclusion including 10 cases without hilar dissection and 80 cases by using infrahepatic inferior vena cava clamping together with Pringle maneuver.The mean operation time and blood loss were （270.7 ±91.4） min, （413.2 ±257.5） ml respectively, and 41 patients received the conversion to open surgery. The overall morbidity was 27.8% and mortality rate within 3 months after surgery was 0.65%.The average postoperative hospital stay was （7.2 ±3.1） d. Conclusion Laparoscopic hepatectomy for liver cancer has been widely used in clinical practice.All kinds of hepatic vascular exclusion techniques are safe and effective, and these techniques are feasible for both major hepatic resection and segmental resection.

关 键 词：癌 肝细胞 腹腔镜检查 肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]