肝尾叶入路在腹腔镜解剖性肝右后区切除术中的应用  

Laparoscopic Right Posterior Anatomical Hepatectomy with Caudate Lobe Approach

作　　者：卿宇豪 段小辉 毛先海[1] QING Yu-hao;DUAN Xiao-hui;MAO Xian-hai(Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Hunan Normal University(Hunan Provincial People's Hospital),Changsha 410005,Hunan,China)

机构地区：[1]湖南师范大学附属第一医院(湖南省人民医院)肝胆外科,长沙410005

出　　处：《中国现代手术学杂志》2022年第6期413-418,共6页Chinese Journal of Modern Operative Surgery

摘　　要：目的 探讨肝尾叶入路在腹腔镜解剖性肝右后区切除术中的可行性,并总结操作经验。方法 2021年1月至2022年4月湖南师范大学附属第一医院(湖南省人民医院)收治接受腹腔镜肝尾叶入路解剖性肝右后区切除手术的肝细胞癌患者46例,回顾性研究其临床资料,分析术中显露肝蒂所用时间、术中出血、术后并发症和术后住院时间与手术方式的关系。结果 所有患者手术顺利完成,其中男性27例,女性19例,中位年龄60.0岁,肝功能Child-Pugh分级A级44例,B级2例;解剖性Ⅵ段切除14例,Ⅶ段切除17例,右后叶(Ⅵ+Ⅶ段)切除15例。46例患者手术切缘均为阴性。术中显露肝蒂所用中位时间18.0 min,术中中位出血量为200.0 mL。术后12例患者出现不同程度并发症,其中7例出现胸腔积液,1例出现胆漏,1例出现腹水,1例出现门静脉主干血栓形成,1例同时出现胆漏、腹水、胸腔积液,1例出现胸腔积液合并腹水。2例术后胆漏患者均引流通畅并带引流管出院,1例门静脉主干血栓形成患者经治疗剂量的肝素抗凝治疗后好转出院,其余9例患者经保守治疗后好转出院。术后中位住院时间7.0 d。结论 肝尾叶入路腹腔镜解剖性肝右后区切除手术,能安全高效地显露并处理右后区肝蒂,优化手术流程。Objective To investigate the feasibility and experience of hepatic caudate lobe approach in laparoscopic anatomical right posterior hepatectomy. Methods The data of 46 patients with hepatocellular carcinoma who underwent laparoscopic right posterior anatomical hepatectomy with caudate lobe approach in the First Affiliated Hospital of Hunan Normal University(Hunan Provincial People’s Hospital) from January 2021 to April 2022 was retrospectively studied. The relationship between intraoperative exposure time of hepatic pedicle, intraoperative blood loss, postoperative complications, postoperative hospital stay and surgical approach was analyzed. Results All patients completed the operation successfully, including 27 males and 19 females with the median age of 60.0 years. There were 44 cases of Child-pugh A and 2 cases of Child-Pugh B. Anatomical segment Ⅵ resection was performed in 14 cases, segment Ⅶ resection in 17 cases, and right posterior lobe(Ⅵ+Ⅶ) resection in 15 cases. All the 46 patients had negative surgical margins. Median time for hepatic pedicle exposure was 18.0 minutes, and the median blood loss was 200.0 mL. There was no blood transfusion during operation. Postoperative complications occurred in 12 patients, including 7 cases with pleural effusion, 1 case with bile leakage, 1 case with ascites, 1 case with main portal vein thrombosis, 1 case with bile leakage, ascites and pleural effusion at the same time, and 1 patient with pleural effusion and ascites. Two patients with postoperative bile leakage were discharged with drainage tube. 1 case with main portal vein thrombosis was discharged after therapeutic dose of heparin anticoagulation. And the other 9 patients with complications were improved and discharged after conservative treatment. The median postoperative hospital stay was 7.0 days.Conclusion Laparoscopic right posterior anatomical hepatectomy with caudate lobe approach can safely and efficiently expose and deal with the hepatic pedicle of the right posterior area and optimize the op

关 键 词：肝细胞癌 腹腔镜肝切除 肝尾叶入路 

分 类 号：R735.7[医药卫生—肿瘤]