腹腔镜下肝尾状叶血管瘤切除术  

Laparoscopic hepatic caudate lobe hemangioma resection

作　　者：陶永泽[1] 刘文超 李晓勇[1] 王婷婷 陈德兴[1] Tao Yongze;Liu Wenchao;Li Xiaoyong Wang Tingting;Chen Dexing(General Surgery Department of Jilin Province Qianwei Hospital,Jilin 130012,China)

机构地区：[1]吉林省前卫医院,长春130012

出　　处：《中华腔镜外科杂志（电子版）》2023年第6期358-360,共3页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的:探讨应用腹腔镜技术切除肝尾状叶肿瘤的可行性。方法:总结分析2023年8月吉林省前卫医院普外科收治的1例肝尾状叶血管瘤患者,术前采自体血、设计手术方案(腹腔镜肝尾状叶切除左侧入路)、备选手术方案(腹腔镜肝尾状叶切除左侧入路联合左半肝切除、右侧入路或联合入路),以及术中突发情况应对措施(控制中心静脉压及肝门阻断),优化围术期管理等。结果:顺利完成腹腔镜下左侧入路肝尾状叶大血管瘤切除术,瘤体切除时间约50 min、术中出血约80 ml。术后第1天拔除胃管、尿管,饮水;第2天拔除中心静脉管,排气,进全流食;第3天拔除1根腹腔引流管,进半流食,排气排便;第5天拔除另1根腹腔引流管,出院。术后ALT、AST、CRP轻度升高,给予抗炎、保肝治疗后较快恢复;术后无出血、胆瘘、肝功能衰竭等严重并发症发生。结论:术前全面评估、设计手术方案及应对措施,术中良好的术野显露、准确辨识解剖关系、精细化处理肝尾状叶肿瘤周围脉管系统是腹腔镜下肝尾状叶肿瘤切除成功的关键。Objective To investigate the feasibility of laparoscopic resection of hepatic caudate lobe tumors.Methods A patient with hepatic caudate lobe hemangioma admitted to Jilin Province Qianwei Hospital in Aug.2023 was summarized and analyzed.Preoperative autologous blood was collected,surgical plan was designed(left approach of laparoscopic caudate lobectomy),alternative surgical plan(left approach of laparoscopic caudate lobectomy combined with left hemihepatectomy,right approach or combined approach),and emergency response measures during the operation(control of central venous pressure and hepatic portal occlusion),and perioperative management was optimized.Results Laparoscopic resection of hepatic caudate lobe hemangioma was completed successfully.The resection time was about 50 min and the intraoperative bleeding was about 80 ml.On the first day after surgery,gastric tube and urinary tube were removed and drinking water was provided.On the second day,the central venous tube was removed,exhaust,liquid feeding were carried out.On the third day,one abdominal drainage tube was removed,half liquid feeding was carried out,and exhaust defecation was performed.On the 5th day,another abdominal drainage tube was removed and discharged.ALT,AST and CRP increased slightly after operation,and recovered quickly after anti-inflammatory and liver protection therapy.There were no serious complications such as bleeding,biliary fistula and liver failure.ConclusionnComprehensive preoperative evaluation,design of surgical plan and countermeasures,well exposure of surgical field,accurate identification of anatomic relationship and fine treatment of peripheral vascular system of hepatic caudate lobe tumor are the keys to successful laparoscopic resection of hepatic caudate lobe tumor.

关 键 词：腹腔镜 肝尾状叶 左侧入路 血管瘤 

分 类 号：R735.7[医药卫生—肿瘤]