腹腔镜肝尾状叶切除术五例临床体会  

Laparoscopic hepatic caudate lobectomy in 5 cases

作　　者：洪晟乾 严雨楼 祁付珍[1] HONG Shengqian;YAN Yulou;QI Fuzhen(Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University,Huai’an,Jiangsu 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院肝胆胰外科,江苏淮安223300

出　　处：《肝胆胰外科杂志》2022年第12期727-730,743,共5页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨腹腔镜肝切除术在尾状叶疾病中的应用价值,总结手术技巧和经验。方法回顾性分析2021年1月至2022年3月南京医科大学附属淮安第一医院肝胆胰外科行腹腔镜尾状叶切除术治疗的3例肝细胞癌和2例肝良性肿物患者的临床资料。术前均行三维重建,准确评估肿瘤的位置和直径。术中均采用左侧入路,3例肝细胞癌术中联合应用ICG荧光显像。围手术期管理应用加速康复理念。3例放置引流管,术后3 d内拔除.术后第1天均拔除导尿管并下床活动。结果患者平均手术时间(158.2±27.6)min,平均出血量(166.4±81.5)mL。术后天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)较术前升高,行保肝治疗后基本恢复正常。3例肝细胞癌患者手术切缘均为阴性。平均住院时间(7.6±0.9)d。结论腹腔镜下尾状叶切除术安全有效,但需要术前精准评估,选择恰当的入路,实现解剖性肝切除。围手术期管理采用加速康复理念可以促进术后恢复,但是否需要常规放置引流管目前仍有争议。Objective To explore the feasibility of laparoscopic hepatic caudate lobectomy and summarize the surgical techniques and experience.Methods Clinical data of 3 patients with hepatocellular carcinoma(HCC)and 2 patients with benign tumors who underwent laparoscopic caudate lobectomy in Huaian No.1People’s Hospital from Jan.2021 to Mar.2022 were retrospectively analyzed.All the 5 cases were performed three-dimensional reconstruction to accurately evaluate the location and diameter of tumors preoperation.Laparoscopic caudate lobectomy was performed via left approach.ICG fluorescence imaging were applicated in the 3 HCC patients during operation.Enhanced recovery after surgery were applied in the managment in perioperative period.Drainage tubes were placed in 3 cases and removed within 3 d postoperation.All the 5patients were removed from the urinary catheter on the first day after operation and got out of bed.Results The average operation time was(158.2±27.6)min and the average bleeding volume was(166.4±81.5)mL.The levels of aspartate aminotransferase(AST)and alanine aminotransferase(ALT)increased after operation compared with those before operation,and recovered to normal after liver protection treatment.Surgical margins of the 3 HCC patients were negative.The average hospitalization time was(7.6±0.9)d.Conclusion Laparoscopic hepatic caudate lobectomy is safe and effective with essential accurate preoperative evaluation and appropriate approach to achieve anatomical hepatectomy.Application of enhanced recovery after surgery in management in perioperative period can promote postoperative recovery,while the necessity of routinely placing drainage tubes is still controversial.

关 键 词：肝尾状叶 腹腔镜肝切除 肝细胞癌 肝脏良性肿物 

分 类 号：R735.7[医药卫生—肿瘤]