腹腔镜解剖性顺时针四切面肝中叶切除的策略与技巧  

Strategies and techniques of laparoscopic anatomical clockwise four-section mesohepatectomy

作　　者：叶青[1] 何军明[1] 彭建新[1] 郑志鹏[1] 刁竞芳[1] 莫嘉强 Ye Qing;He Junming;Peng Jianxin;Zheng Zhipeng;Diao Jingfang;Mo Jiaqiang(Department of Hepatobiliary Surgery,Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]广东省中医院肝胆胰外科,广州510120

出　　处：《中华肝脏外科手术学电子杂志》2020年第2期164-167,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜解剖性肝中叶切除的手术技巧与要点。方法回顾性分析2017年3月至2019年1月广东省中医院行腹腔镜解剖性肝中叶切除的12例肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男9例,女3例;年龄43~72岁,中位年龄55岁。解剖第一肝门,显露、悬吊肝右前和左内叶肝蒂,控制出血,采用腹腔镜解剖性顺时针四切面肝中叶切除法,顺时针依次离断左侧、足侧、右侧、头侧切面。观察患者围手术期情况。结果患者均顺利完成手术,无中转开腹,无围手术期死亡。手术时间中位数为226(177~288)min,术中出血量295(50~800)ml。术后发生胸腔积液1例,胆漏1例,均通过保守治疗治愈。术后7 d肝功能基本恢复正常。术后平均住院时间(6.5±2.3)d。结论腹腔镜肝中叶切除有一定的挑战性,正确地选择肝切面,有效地控制术中出血,腹腔镜顺时针四切面肝中叶切除法是安全、可行的。Objective To explore the surgical techniques and keypoints of laparoscopic anatomical mesohepatectomy.Methods Clinical data of 12 patients with liver cancer who underwent laparoscopic anatomical mesohepatectomy in Guangdong Provincial Hospital of Traditional Chinese Medicine from March 2017 to January 2019 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,9 patients were male and 3 female,aged 43-72 years old with a median age of 55 years old.The porta hepatis was dissected,and the right anterior and left medial lobe pedicles were exposed and suspended to control the hemorrhage.Laparoscopic anatomical clockwise four-section mesohepatectomy was employed to separate the left,foot,right and head sections.Perioperative conditions of patients were observed.Results The operations of all patients were completed successfully without conversion to open surgery or perioperative death.The median operation time was 226(177-288)min and the intraoperative blood loss was 295(50-800)ml.Postoperative pleural effusion occurred in 1 case and bile leakage in 1 case,which were cured by conservative treatments.Liver function was basically restored to normal at postoperative 7 d.The average length of postoperative hospital stay was(6.5±2.3)d.Conclusions Laparoscopic mesohepatectomy isa challenging procedure.Laparoscopic clockwise four-section mesohepatectomy is a safe and feasible option,when the liver section is decided appropriately and intraoperative hemorrhage is controlled effectively.

关 键 词：腹腔镜 肝切除术 失血 手术 

分 类 号：R735.7[医药卫生—肿瘤]