右侧肝实质优先入路在腹腔镜肝右后上区良性占位性病变切除中的应用  

Application of right hepatic parenchymal transection-first approach during laparoscopic resection of benign occupation lesions in superior segment of right hepatic posterior

作　　者：吴柯 赵志平 李靖 王峥 王梁 尤楠 郑璐 Wu Ke;Zhao Zhiping;Li Jing;Wang Zheng;Wang Liang;You Nan;Zheng Lu(Department of Hepatobiliary Surgery,Second Affiliated Hospital,Third Military Medical University(Army Medical University),Chongqing 400037,China;No.953 Army Hospital,Shigatse Branch of Xinqiao Hospital,Third Military Medical University(Army Medical University),Tibet Autonomous Region Shigatse 857000,China)

机构地区：[1]陆军军医大学第二附属医院肝胆外科,重庆400037 [2]陆军军医大学第二附属医院日喀则分院(陆军第九五三医院)普通外科,西藏日喀则857000

出　　处：《腹部外科》2024年第5期367-371,共5页Journal of Abdominal Surgery

基　　金：重庆市科卫联合医学科研项目面上项目(2023MSXM004);陆军军医大学科技创新能力提升专项项目(2022XJS20);陆军军医大学第二附属医院青年博士人才孵化计划项目(2022YQB031);重庆市自然科学基金面上项目(CSTB2022NSCQ-MSX1160);西藏自治区自然科学基金青年项目(XZ202401ZR0071)。

摘　　要：目的探讨右侧肝实质优先入路在腹腔镜肝右后上区良性占位性病变切除中的临床应用价值。方法回顾性分析2022年1月至2024年1月在陆军军医大学第二附属医院行腹腔镜下右侧肝实质优先入路的肝右后上区良性占位性病变切除的21例病人临床相关资料,对手术时间、术中出血量、术后并发症(术后出血、胆漏等)、术后住院时间等指标进行记录并分析。结果所有病人无术中输血,无中转开腹,无严重并发症。全部病例经术后病理明确诊断,其中肝脏血管瘤11例、局灶性结节性增生6例、肝脏腺瘤4例。手术时间为(310±10)min,术中出血量为(300±87)mL,术后住院时间为(7±3)d。结论经右侧肝实质优先入路的腹腔镜下肝右后上区良性占位性病变切除是安全而有效的,在缩短手术时间的同时还可以降低手术操作难度,提高手术安全性,值得推广应用。Objective To explore the clinical application value of right hepatic parenchymal transection-first approach during laparoscopic resection of benign occupation lesions in superior segment of right hepatic posterior.Methods From January 2022 to January 2024,the relevant clinical data were retrospectively reviewed for 21 laparoscopic resections for benign occupation lesions in superior segment of right hepatic posterior by right hepatic parenchymal transection-first approach.Operative duration,intraoperative volume of blood loss,postoperative hemorrhage,bile leakage and postoperative hospital stay were recorded.Results There was no instance of intraoperative blood transfusion,conversion into laparotomy or severe complications.The pathological diagnoses were hepatic hemangioma(n=11),focal nodular hyperplasia(n=6)and hepatic adenoma(n=4).Average operative duration of laparoscopic group was(310±10)min,average volume of blood loss(300±87)mL and postoperative hospitalization stay(7±3)day.Conclusion Right hepatic parenchymal transection-first approach for laparoscopic resection of benign occupation lesions in superior segment of right hepatic posterior is both safe and efficacious.It may shorten operative duration,boost operative safety and lower operative difficulty.A wider popularization is worthwhile.

关 键 词：肝脏良性占位性病变 肝右后上区 腹腔镜 右侧入路 肝实质优先 

分 类 号：R657.3[医药卫生—外科学]