摘要
目的 探讨腹腔镜下肝切除术的可行性及相关技术问题如术中出血的控制、肝实质离断方法和肝断面的处理方法等.方法 自2011年6月至2014年4月共施完全腹腔镜肝切除术20例,对其临床资料进行回顾性分析.结果 20例患者中肝血管瘤10例,肝细胞性肝癌9例,乙状结肠癌肝转移1例.2例位于肝脏第Ⅱ和第Ⅲ段,8例位于第Ⅲ段,7例位于第Ⅵ段,第Ⅳb、Ⅴ、Ⅶ段各1例.平均肿瘤直径（4.7±1.9） cm.肝肿瘤局部切除6例,肝左外叶切除7例,肝右后叶切除2例,肝段切除5例.单独使用超声刀离断肝组织8例,超声刀联合Habib4X射频止血凝固器离断肝组织6例,超声刀联合Endo GIA离断肝组织6例.平均手术时间（196±57） min,术中出血量（380±459）ml,术后出现中等量腹水1例、胆漏1例,顽固性胸腔积液1例,均经保守治疗治愈.术后平均住院时间（9.2±3.5）d.10例恶性肿瘤患者术后随访1～35个月,5例出现肝内复发.结论 在严格掌握手术适应证的前提下,腹腔镜肝切除术是安全可行的;根据肝脏质地的不同,选择不同离断肝实质的器械,可减少术中出血.
Objective To investigate the feasibility of laparoscopic liver resection and related techniques such as intraoperative bleeding control,liver parenchyma transection and liver section han dling.Methods From 2011 June to 2014 April,20 patients were performed total laparoscopic liver re section in our hospital,the clinical data were retrospectively analysized.Results Solid tumors consis ted of liver hemangioma（n-10）,hepatocellular carcinoma（n-9）and colon cancer liver metastasis（n=1）.The tumors located in left lateral lobe（n-2）,segment Ⅲ （n-8）,segment Ⅵ （n-7）,segment Ⅳ b（n-1）,segment Ⅴ （n-1）,and segment Ⅶ （n-1）.The average tumor size was（4.7 ± 1.9） cm.Tunor wedge resection in 6 cases,left lateral lobectomy in 7 cases,right posterior lobectomy in 2 ca ses,segmentectomy in 5 cases.For transection of liver parenchyma,harmonic scalpel was only used in 8 cases,harmonic scalpel combined with Habib4X RF hemostatic coagulator was used in 6 cases,har monic scalpel combined with Endo GIA was used in 6 cases.The average operation time was（196 ± 57） min,the average amount of bleeding was （380 ± 459） ml.Postoperative complications included moder ate ascites in 1 cases,bile leakage in 1 cases and intractable pleura1 effusion in 1 cases and were treated by conservative therapy.The average hospitalization time was（9.2 ± 3.5）days.10 patients with malig nant tumor were followed up for 1～35 months,5 patients with intrahepatic recurrence.Conclusions Total laparoscopic liver resection is safe and feasible for some sdected patients,On the basis of different liver texture,using different transection equipments could reduce intraoperative bleeding.
出处
《腹部外科》
2014年第3期193-196,共4页
Journal of Abdominal Surgery
关键词
腹腔镜
肝切除术
肝肿瘤
出血控制
Laparoscopes
Hepatectomy
Liver neoplasms
Bleeding control
作者简介
通信作者：袁玉峰Email：yuanyf1971@163．com
