术中超声引导下肝实质优先头侧入路腹腔镜解剖性肝Ⅷ段切除手术  

Intraoperative Ultrasound-guided Laparoscopic Anatomical Liver Resection of SegmentⅧthrough Preferential Cephalic Approach of Liver Parenchyma

作　　者：王文儿[1] 田潭平 田林 WANG Wen-er;TIAN Tan-ping;TIAN Lin(Department of Hepatobiliary Surgery,People's Hospital of Xiangxi Autonomous Prefecture(the First Affiliated Hospital of Jishou University),Jishou416000,Hunan,China)

机构地区：[1]湘西土家族苗族自治州人民医院(吉首大学第一附属医院)肝胆外科,湖南吉首416000

出　　处：《中国现代手术学杂志》2021年第5期341-346,共6页Chinese Journal of Modern Operative Surgery

基　　金：湖南省卫健委科研资助项目(20200742)。

摘　　要：目的探讨术中超声引导下肝实质优先头侧入路腹腔镜解剖性肝Ⅷ段切除手术的手术要点、安全性和可行性。方法采用回顾性描述性研究方法,收集2018年6月至2021年5月湘西土家族苗族自治州人民医院(吉首大学第一附属医院)收治的4例行腹腔镜解剖性肝Ⅷ段切除手术病人的临床资料(肝细胞癌1例,结肠癌肝转移瘤1例,肝内胆管细胞癌1例,Caroli病合并肝内胆管结石1例)。其中男1例,女3例;中位年龄为48.7(37.0~72.5)岁。4例病人均采用术中超声引导下肝实质优先头侧入路完成腹腔镜解剖性肝Ⅷ段切除手术。结果①手术情况:4例病人均顺利完成腹腔镜解剖性肝Ⅷ段切除手术,无中转开腹。手术时间分别为196.40 min(肝细胞癌)、235.03 min(结肠癌肝转移)、313.93 min(肝内胆管细胞癌)及312.65 min(Caroli病合并肝内胆管结石);肝门阻断时间分别为74.83 min、78.34 min、51.39 min及45.45 min;术中出血量分别为127.93 ml、242.05 ml、161.83 ml及286.20 ml。4例病人无术中输血,3例肿瘤病人手术切缘均为阴性,1例Caroli病合并肝内胆管结石病灶完整切除。②术后情况:4例病人术后住院时间分别为5 d、8 d、7 d和9 d。4例病人均未发生术后出血、胆瘘、肝脓肿和腹腔感染等并发症。1例肝胆管结石病人术后未见扩张胆管及结石残留。③随访情况:4例病人均获得随访,中位随访时间为17.6(3~34)个月。随访期间,3例恶性肿瘤病人未见复发,1例良性病人术后生活质量良好。结论术中超声引导下肝实质优先头侧入路腹腔镜解剖性肝Ⅷ段切除手术是安全、可行的。Objective To investigate the procedure key points,safety and feasibility of intraoperative ul-trasound-guided laparoscopic anatomical liver resection of segmentⅧ.Methods A retrospective descriptive study was used.The clinicopathological data of 4 patients(1 case of hepatocellular carcinoma,1 case of liver metastasis of colon cancer,1 case of intrahepatic cholangiocarcinoma and 1 case of Caroli disease complicated with intrahepatic bile duct stones)treated in the People's Hospital of Xiangxi Autonomous Prefecture(the First Affiliated Hospital of Jishou University)from June 2018 to May 2021 were collected.There were 1 male and 3 fe-male.The median age was 48.7(37.0~72.5)years old.All 4 patients underwent laparoscopic anatomical liver resection of segmentⅧthrough the preferential cephalic approach of liver parenchyma guided by intraoperative ultrasound.Results①All patients successfully completed laparoscopic anatomical liver resection of segmentⅧwithout conversion to laparotomy.Operation time of 4 patients was 196.40 min,235.03 min,313.93 min and 312.65 min respectively.Blocking time of hilar was 74.83 min,78.34 min,51.39 min and 45.45 min.And the amount of intraoperative bleeding was 127.93 ml,242.05 ml,161.83 ml and 286.20 ml.There was no in-traoperative blood transfusion,nor positive margin in the tumor patients.1 case of Caroli disease complicated with intrahepatic bile duct got stone-free after operation.②The postoperative hospital stay of 4 patients was 5d,8d,7d and 9d.No complications were found such as postoperative bleeding,biliary fistula,liver abscess or ab-dominal infection.No dilated bile duct or residual stones were found in the hepatolithiasis patient.③All 4 pa-tients were followed up for 3.0~34.0 months,with a median of 17.6 months.During the follow-up period,no recurrence was found in 3 patients with malignant tumors.One benign patient had good quality of life after oper-ation.Conclusion It is safe and feasible of the intraoperative ultrasound-guided laparoscopic anatomical liv-er resect

关 键 词：解剖性肝段切除术 肝Ⅷ段 腹腔镜检查 术中超声 肝实质优先入路 头侧入路 

分 类 号：R657.3[医药卫生—外科学] R735.7[医药卫生—临床医学]