血管夹肝门阻断法在复杂腹腔镜左半肝切除术中的应用  

Application of hepatic portal occlusion with vascular clamp in complex laparoscopic left hemihepatectomy

作　　者：张成[1] 李畅 钟凯航 温耀鸿 何国林[1] 蔡磊[1] 程远[1] 付顺军 刘海燕[1] 潘明新 Zhang Cheng;Li Chang;Zhong Kaihang;Wen Yaohong;He Guolin;Cai Lei;Cheng Yuan;Fu Shunjun;Liu Haiyan;Pan Mingxin(DepartmentⅡof Hepatobiliary Surgery,Zhujiang Hospital of Southern Medical University,Guangzhou 510220,China)

机构地区：[1]南方医科大学珠江医院肝胆二科,广州510220

出　　处：《中华肝脏外科手术学电子杂志》2022年第5期493-497,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省医学科学技术研究基金(A2020613);广州市科技计划项目(201508020053)。

摘　　要：目的探讨血管夹肝门阻断法在复杂腹腔镜左半肝切除术中应用的安全性和疗效。方法回顾性分析2019年8月至2021年3月南方医科大学珠江医院行腹腔镜左半肝切除术的3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。其中女2例,男1例;年龄分别为45、61、55岁。原发病分别为肝血管瘤、肝内胆管结石、肝细胞癌。术前肝功能Child-Pugh分级均为A级。既往均有腹部肝胆手术史。术中见肝脏与腹壁粘连严重,肝十二指肠韧带周围粘连严重,肝门与十二指肠界限不清,采用血管夹阻断第一肝门,血管夹总长7.0 cm,夹口长4.5 cm,由主操作孔进入。观察患者围手术期情况。结果3例患者均术程顺利,无中转开腹。例1手术时间240 min,术中出血量约400 ml,阻断1次,阻断时间14 min。例2手术时间230 min,术中出血量约300 ml,阻断1次,阻断时间12 min。例3手术时间280 min,术中出血量约600 ml,术中输血400 ml,因切肝过程断面渗血较多阻断2次,阻断时间共29 min。患者术后肝功能均恢复顺利,术后住院时间分别为6、5、8 d,均未发生并发症。术后病理检查示例1为肝左叶海绵状血管瘤,例2为肝内胆管结石,例3为肝左叶肝细胞癌。结论血管夹阻断入肝血流用于腹腔镜肝切除术安全、可行,其主要适用于有肝脏手术史、第一肝门粘连严重而解剖困难的复杂左半肝切除患者,可有效减少术中出血,且操作简便。Objective To evaluate the safety and efficacy of hepatic portal occlusion with vascular clamp in complex laparoscopic left hemihepatectomy.Methods Clinical data of 3 patients undergoing laparoscopic left hemihepatectomy in Zhujiang Hospital of Southern Medical University from August 2019 to March 2021 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,2 patients were female and 1 male,aged 45,61 and 55 years,respectively.Primary diseases were hepatic hemangioma,hepatolithiasis and hepatocellular carcinoma,respectively.The liver function of 3 patients were Child-Pugh grade A before operation.All patients had history of abdominal hepatobiliary surgery.Intraoperatively,severe liver-abdominal wall adhesion was observed,severe liver-duodenal ligament adhesion was also seen,and the boundary between hepatic hilus and duodenum was unclear.The porta hepatis was occluded with vascular clamp.The total length of vascular clamp was 7.0 cm and the length of clamp opening was 4.5 cm,which was placed through the main operating trocar site.Perioperative conditions of 3 patients were observed.Results All 3 patients successfully completed the surgery without conversion to open surgery.For case 1,the operation time was 240 min,intraoperative blood loss was approximately 400 ml,occlusion was performed once and the occlusion time was 14 min.For case 2,the operation time was 230 min,and intraoperative blood loss was approximately 300 ml,occlusion was performed once and the occlusion time was 12 min.For case 3,the operation time was 280 min,intraoperative blood loss was approximately 600 ml,and intraoperative blood transfusion was 400 ml.Twice occlusion was performed due to increased errhysis on the transection plane during hepatectomy,the total occlusion time was 29 min.Postoperatively,liver function of all patients was properly recovered.The length of postoperative hospital stay was 6,5 and 8 d,respectively.No complications were observed.Po

关 键 词：肝切除术 腹腔镜 肝门阻断 

分 类 号：R657.3[医药卫生—外科学]