摘要
目的总结和探讨腹腔镜肝切除患者围手术期常见并发症及其预防和治疗。方法回顾性分析该中心2008～2011年143例腹腔镜肝切除手术病例的临床资料。其中原发性肝癌59例,胆管癌25例,肝内胆管结石34例,肝血管瘤20例,局灶性结节增生5例。肿瘤直径大小2.0～8.0cm。143例患者中肝硬化48例。行腹腔镜左半肝切除46例,腹腔镜左肝外叶切除51例,Ⅴ段切除21例,Ⅴ/Ⅵ段切除14例,右半肝切除3例,肝局部切除8例。结果中转开腹1例,总的术后并发症发生率为7.8%,并发症包括出血2例,胆漏3例,腹腔积液2例,肺部感染及胸腔积液2例,肝功能不全并腹腔积液1例。腹腔镜肝切除术后并发症的发生与患者的年龄、性别、肝切范围、肿瘤大小、疾病性质无关(P>0.05),与患者术前肝硬化、术中出血量有关(P<0.05)。结论重视术前评估,术中谨慎操作,娴熟的腹腔镜操作技巧,加强术后管理是预防腹腔镜肝切除术后并发症的重要环节。
[Objective] To summarize and analyze prevention and treatment of perioperative complications of laparoscopic hepatectomy patients.[Methods] 143 patients underwent laparoscopic hepatectomy from Mar 2008 to Dec 2011 at our center were retrospectively analyzed according to their clinical data.These patients included 59 of primary liver cancer,25 of bile duct carcinoma,34 of hepatolithiasis,20 of liver hemangioma,5 of liver focal hyperplasia of nodules.The type of laparoscopic hepatectomy was left lateral sectionectomy（n=46）,left hepatectomy（n=51）,segmentectomy（n=21）,bisegmentectomy（n=14）,right hepatectomy（n=3） and local resection（n=8）.[Results] 1 case converted to laparotomy,2 cases bleeding,3 cases of bile leakage,2 cases abdominal cavity effusion,2 cases pulmonary infection and pleural effusion,hepatic insufficiency with abdominal cavity effusion.The incidence of complications after Laparoscopic hepatectomy in this study,which related to cirrhosis and Blood loss（P 0.05）,did not relate to the patient sex,age,range of liver resection,tumor size and disease character（P 0.05）.[Conclusions]Preoperative assessment and perioperative prudent operation,prudent operation,skilled laparoscopic operation,strict management are the important factors to prevent the complications of laparoscopic hepatectomy.
出处
《中国内镜杂志》
CSCD
北大核心
2012年第4期354-357,共4页
China Journal of Endoscopy
关键词
腹腔镜肝切除
并发症
预防和治疗
laparoscopic hepatectomy
complications
prevention and treatment
作者简介
[通信作者]张阳德，E-mail：ZYD99@189．cn
