腹腔镜小儿肝切除术21例报告  

Laparoscopic resection for hepatic masses in children: a report of 21 cases

作　　者：郑百俊[1] 段怡涛[1] 高亚[1] 余辉[1] 龚伟[1] 潘伟康[1] 黄强[1] 李鹏[1] 吴宣林[1] Zheng Baijun;Duan Yitao;Gao Ya;Yu Hui;Gong Wei;Pan Weikang;Huang Qiang;Li Peng;Wu Xnanlin(Department of Pediatric Surgery,Second Affiliated Hospital,Xi'an Jiaotong University,Xi'an710004 ,China)

机构地区：[1]西安交通大学第二附属医院小儿外科,710004

出　　处：《中华小儿外科杂志》2019年第7期608-612,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨腹腔镜肝切除术的可行性及疗效。方法回顾性分析自2005年11月至2018年5月在西安交通大学第二附属医院小儿外科诊断为肝脏占位并接受腹腔镜肝切除术的21例患儿的临床资料、围手术期检査与处理、手术情况及术后随访资料。其中男10例,女11例,手术时平均年龄为21.6个月,范围为1.5.74个月。肝母细胞瘤(hepatoblastoma,HB)术前依据PRETEXT、POSTTEXT分期系统进行分期。所有患儿中良性占位5例,HB16例。肝占位最长径平均为6.9cm,范围3.8~16.0cm。对PRETEXT Ⅱ~Ⅳ期的14例HB患儿术前接受以钳类为基础的化疗2~4个疗程,化疗后POSTTEXT分期为Ⅰ期3例、Ⅱ期7例、Ⅲ期4例。全组行非解剖性切除6例(S62例,S5-64例),解剖性切除15例(左外叶5例,左半肝4例,左半肝+S5、S6肿瘤切除1例,左半肝+尾状叶切除1例,右半肝2例,左三叶2例)。结果手术时间平均为240min,范围为100.390min;出血量平均为60ml,范围为15.300ml;术中输血7例冲转手术2例。无围手术期死亡病例。HB均获R0切除,平均切缘1.0cm,范围为0.2~3.0cm。术后1~2d即可活动及进食,无并发症的患儿术后住院时间为(7.3±1.3)d,范围为6~10d。术后并发症4例,包括肝断面包裹性积液1例,胆漏3例。2例胆漏及包裹性积液患儿引流自愈,1例胆漏经再次手术治愈。术后随访时间平均为39个月,范围为4个月至12年,良性占位患儿均存活无复发。16例HB患儿术后1年内有3例复发。16例HB患儿的随访情况:7例术后随访超过3年,其中5例无瘤存活;9例术后随访时间不足3年,其中无瘤存活8例,带瘤存活1例。结论对合适的患儿,腹腔镜肝切除术安全可行,可作为小儿肝切除手术的一种新选择。Objective To evaluate the safety and feasibility of laparoscopic hepatic resection in children. Methods Clinical data were retrospectively analyzed for patients with hepatic masses underwent laparoscopic resection from November 2005 to May 2018. The relevant data included personal demographics, perioperative examinations佲 intraoperative data, postoperative complications and follow-ups. The extent of hepatoblastoma was determined by the PRETEXT and the POSTTEXT staging systems. Results A total of 21 children, including 10 boys and 11 girls, were enrolled with a median operative age of 21. 6 (1. 5-74) months. The lesions were benign (n= 5) and hepatoblastoma (n= 16). The longest average diameter of hepatic masses was 6. 9 (3. 8-16. 0) cm. Fourteen children with hepatoblastoma of PRETEXT stage Ⅱ~Ⅳ received platinum-based chemotherapy for 2 to 4 courses preoperatively and downgraded to POSTTEXT stages I (n = 3).Ⅱ(n = 7) and Ⅲ(n = 4). Non-anatomical hepatic resection was performed for S6(n = 2) and S5-6 (n = 4) and 15 patients underwent anatomical resection, including left lateral sectionectomy (n= 5), left hepatectomy (n= 4), left hepatectomy plus S5-6 tumor resection (n= 1), left hepatectomy plus caudate lobe resection (n = 1), right hepatectomy (n = 2) and extended left hepatectomy (n = 2). Seven patients received red blood cell transfusion and another 2 patients were converted into laparotomy. There was no peri-operative mortality. All operative duration was 240 (100-390) min and median estimated blood loss 60 (15-300) ml. Seven patients underwent RO resection with an average margin of 1. 0 (0. 2-3. 0) cm. Some of them resumed a diet within 1-2 days postoperatively and uneventful patients were discharged at an average length of 7. 3 (6-10) days postoperatively. Postoperative complications occurred in 4 cases, including encapsulated effusion (n= 1) and bile leakage (n = 3). Among these 4 cases, one child with bile leakage was cured by re-operation while the remainders were managed by drainage. The average

关 键 词：腹腔镜 肝切除术 肝母细胞瘤 化学治疗 

分 类 号：R726.5[医药卫生—儿科]