经肝门板半肝阻断在腹腔镜半肝切除术中的应用  

Application of hemihepatic vascular occlusion through hilar plate in laparoscopic hemihepatectomy

作　　者：李梅生[1] 胡建垣 陈应军[1] 甄作均[1] Li Meisheng;Hu Jianyuan;Chen Yingjun;Zhen Zuojun(Department of Hepatopancreatobiliary Surgery,the First People＇s Hospital of Foshan,Foshan 528000,China)

机构地区：[1]佛山市第一人民医院肝脏胰腺外科,广东省528000

出　　处：《中华肝脏外科手术学电子杂志》2018年第6期473-476,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省医学科研基金(A2014697)

摘　　要：目的探讨经肝门板半肝阻断在腹腔镜半肝切除术中的临床应用价值。方法回顾性分析2010年9月至2017年12月在佛山市第一人民医院行腹腔镜肝切除术的32例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男20例,女12例;年龄28~71岁,中位年龄46岁。行左半肝切除18例,右半肝切除14例。观察患者术中及术后情况。结果 32例患者中成功施行经肝门板半肝阻断30例,1例因肝门局部粘连改行鞘内离断肝动脉和门静脉,1例术中因肝硬化严重导致肝门处明显出血改行开腹手术。肝实质离断过程中4例因大出血中转开腹。经肝门板半肝阻断平均时间为(12±5)min,手术时间为(176±52)min,术中出血量为中位数360(50~1 400)ml。术后胆漏9例,均经充分引流后治愈。肝创面出血1例,经输血治疗后治愈。患者术后住院时间为(7.1±2.6)d。无术后肝衰竭,无围手术期死亡。结论经肝门板半肝阻断是一种切实可行、效果确切、安全可靠的入肝血流阻断方法,在腹腔镜半肝切除术中具有较高的临床应用价值。Objective To evaluate the clinical application value of hemihepatic vascular occlusion through hilar plate in laparoscopic hemihepatectomy. Methods Clinical data of 32 patients undergoing laparoscopic hemihepatectomy in the First People＇s Hospital of Foshan from September 2010 to December 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among 32 patients, 20 cases were male and 12 were female, aged 28-71 years with a median age of 46 years. Laparoscopic left hemihepatectomy was performed in 18 cases and laparoscopic right hemihepatectomy in 14 cases. Intraoperative and postoperative physical conditions were observed. Results 30 cases successfully underwent hemihepatic vascular occlusion through hilar plate, 1 case was converted to intrathecal dissection of hepatic artery and portal vein due to local hepatic portal adhesion and 1 case was converted to open surgery due to hepatic portal hemorrhage induced by severe liver cirrhosis. During the process of liver resection, 4 cases were converted to open surgery due to massive hemorrhage. The average length of hemihepatic vascular occlusion through hilar plate was （12±5） min, the operation time was （176±52） min and the median intraoperative blood loss was 360 （50-1 400） ml. Postoperative bile leakage occurred in 9 cases, who were cured after adequate drainage. Liver trauma bleeding was observed in 1 case,who was cured after blood transfusion. Postoperative length liver failure or perioperative death occurred. Conclusions plate is a feasible, efficacious, safe and reliable approach applied in laparoscopic hemihepatectomy. of hospital stay was （7.1±2.6） d. No postoperative Hemihepatic vascular occlusion through hilar for hepatic blood flow occlusion, which can be

关 键 词：腹腔镜 肝切除 血流阻断 肝门板 

分 类 号：R657.3[医药卫生—外科学]