腹腔镜肝中叶切除术治疗原发性肝癌21例报告  

Laparoscopic mesohepatectomy for primary liver cancer:a report of 21 cases

作　　者：彭俊杨 杨培[1] 曾新桃[1] 陈思瑞[1] 张伟[1] 罗华[1] PENG Jun-yang;YANG Pei;ZENG Xin-tao(Department of Hepatobiliary Surgery,Mianyang Central Hospital,Mianyang 621000,China)

机构地区：[1]绵阳市中心医院肝胆外科,四川绵阳621000

出　　处：《腹腔镜外科杂志》2020年第5期352-355,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜肝中叶切除术治疗原发性肝癌的安全性及可行性。方法:收集腹腔镜肝中叶切除术治疗21例原发性肝癌患者的临床资料,其中男9例,女12例;32~71岁,平均(46.3±16.2)岁。分析手术时间、术中出血量、术后住院时间、术后并发症等指标。结果:20例患者成功完成腹腔镜肝中叶切除术,1例中转开腹;2例患者术中联合微波消融。手术时间285~360 min,平均(300.5±87.6)min;术中出血量200~1800 mL,平均(510.2±380.7)mL;术后住院6~18 d,平均(8.5±3.7)d。术后胆漏2例(9.5%),1例经充分引流保守治疗治愈;1例在超声引导下穿刺引流后治愈。肝功能衰竭(B级)1例(4.8%),予以保肝、白蛋白支持等治疗,患者肝功能好转出院。术后病理:肝细胞癌16例,胆管细胞癌4例,混合细胞癌1例,手术切缘均为阴性。结论:有选择性地采用腹腔镜肝中叶切除术治疗原发性肝癌,由腹腔镜技术熟练的医师施术是安全、可行的。Objective:To explore the safety and feasibility of laparoscopic mesohepatectomy for primary liver cancer.Methods:The clinical data of 21 patients with primary liver cancer treated by laparoscopic mesohepatectomy were collected.There were 9 males and 12 females aged from 32 to 71 years old,with an average age of(46.3±16.2)years.The operative time,intraoperative blood loss,postoperative hospital stay and postoperative complications were analyzed.Results:Twenty patients were successfully operated with laparoscopic mesohepatectomy,one patient was converted to open surgery.No unplanned reoperation or perioperative death occurred.Two cases were combined with microwave ablation during operation.The operation time ranged from 285 to 360 min,with an average of(300.5±87.6)min.The intraoperative blood loss was 200-1800 mL,and the average was(510.2±380.7)mL.Also,the postoperative hospital stay was 6-18 d,with an average of(8.5±3.7)d.Two patients(9.5%)suffered from bile leakage,one was cured by conservative drainage and the other was cured by percutaneous drainage under ultrasound guidance.One patient(4.8%)suffered liver failure(grade B)and was treated with liver protection and albumin,and the patient's liver function improved finally.Postoperative pathology included 16 cases of hepatocellular carcinoma,4 cases of cholangiocarcinoma,1 case of combined hepatocellular carcinoma and cholangiocarcinoma.All had negative surgical margins.Conclusions:It is safe and feasible to treat primary liver cancer by laparoscopic mesohepatectomy selectively,if performed by an experienced surgeon.

关 键 词：原发性肝肿瘤 腹腔镜检查 肝中叶切除术 

分 类 号：R735.7[医药卫生—肿瘤]