完全腹腔镜解剖性右半肝切除四例

目的 探讨腹腔镜下右半肝切除的方法 和临床效果.方法 于完全腹腔镜下解剖、阻断相应肝段、肝叶的入出肝血流,按解剖学标志切除右半肝共4例,其中3例右肝血管瘤、1例外伤性肝破裂.结果 4例患者均成功地在腹腔镜下施行了右肝切除术,无中转开腹,手术时间(470±42.7)min,术中出血量(1950±881.3)ml,术后住院(15±2.9)d,未发现并发症.结论 对于经过临床选择的病例,完全腹腔镜右半肝切除是安全可靠的微创方法,对肝脏良性疾病完全腹腔镜下病灶切除更具微创意义.

Abstract：

Objective To explore the method and clinical effect of laparoscopic anatomical right liver resections. Method The candidates for laparoscopic right hepatic lobectomys were 4 cases including 3 cases of liver hemangioma and 1 case of hepatorrhexis. Results The laparoscopic right hepatic lobectomy we performed saccess bully in all the 4 patients, operation time was (470±42.7)min. The blood loss in operation was ( 1950± 881.3) ml. The postoperative hospital stay was ( 15 ± 2.9) days.There was not complcation. Conclusions Laparoscopic right hepatic libectomy is feasible and safe.For the patients with benign liver disease, it is an operation with less operation wound.     

腹腔镜肝切除术治疗肝血管瘤22例临床分析

Objective To investigate technical features and efficacy of laparoscopic liver resec-tion for hepatic hemangioma. Methods The clinic data of 22 patients with hepatic hemangioma receiv-ing laparoscopic liver resection in our hospital from March 2007 to February 2008 were retrospectively analyzed. Results Twenty patients received successful total laparoseopie liver resection and 2 conver-sion to laparotomy. Anatomical liver resection was performed in 14 patients including 5 with left hemi-hepateetomy, 5 with left lateral segmentectomy (1 combined with radiofrequeney ablation for the tumor in the right liver lobe) and 4 with segment Ⅵ resection. Eight patients underwent nonanatomi-cal hepatectomy. The liver parenchyma of 10 patients were transected under regional hemi-hepatic blood occlusion, 7 under intermittent Pringle's manoeuvre, and 5 without hepatic blood inflow block-age. The mean operative duration was 209 rain (92-375 min) and mean blood loss 360ml (50-1300 ml). No operative death and postoperative complications occurred, and the patients recovered well. The mean postoperative hospital stay was 6 d (4-10 d). All the patients were followed up for 2-14 months and no recurrence was found. Conclusion The advantages of laparoseopie liver resection for hepatic hemangioma are safe operation, less complications, and quick postoperative recovery. The key points are right choice of surgical approach, effective control of hepatic blood inflow, proper man-agement of cutting surface of liver, and liver parenchyma amputation being performed 0. 5-1 cm to tumor margin in the normal parenchyma or anatomical liver resection.     

肝静脉阻断技术在近第二肝门巨大肝血管瘤切除术中的应用

目的 探讨肝静脉肝外阻断在近第二肝门肝脏巨大血管瘤切除术中的应用.方法 回顾分析2003年1月至2009年12月施行19例近第二肝门肝脏巨大血管瘤切除术患者的临床资料.分为肝静脉阻断(hepatic vein exclusion,HVE)组(9例)与下腔静脉阻断(inferior vena cava exclusion,IVE)组(10例),记录患者术中出血量、输血量、术后肝功能恢复情况和术后2 d平均腹腔引流量和并发症发生率等指标.结果 两组患者年龄、性别和瘤体大小的差异均无统计学意义;HVE组中未发生切肝前肝静脉分离过程中损伤;9例肝血管瘤均采用血管瘤体剥除术顺利切除,IVE组1例行右半肝切除;HVE组术中出血及输血量分别为(220±121)ml和(44±88)ml,明显少于IVE组(945±978)ml和(560±717)ml(P＜0.05);HVE组5例切除肝脏血管瘤过程中出现肝静脉损伤未发生大出血,而IVE组4例肝静脉损伤2例术中大出血;术后第1天丙氨酸转氨酶,术后第3天总胆红素HVE组均低于IVE组;术后2 d平均引流量HVE组明显少于IVE组;治疗总费用HVE组低于IVE组.结论 应用肝静脉阻断技术可以增加近第二肝门巨大血管瘤手术切除的安全性,减少治疗费用.

Abstract：

Objective To evaluate hepatic vein exclusion (HVE) outside the liver in the resection of giant hepatic hemangioma near the second hepatic hilum. Methods From January 2003 to December 2009, giant hepatic hemangiomas near the second hepatic hilum were resected in 19 cases. Preoperatively 19 cases were divided into two groups: HVE group (9 cases) and IVE group ( 10 cases). Data regarding the intra-operative and postoperative courses of the patients were analyzed. Results There was no difference between the 2 groups regarding the age, sex and tumor size. No damage of hepatic vein was happened in HVE group. Resection of the hemangioma was applied in all cases of HVE group, and 1 case in IVE group had right hemi-hepatectomy. Hepatic veins rupture occurred in 4 cases in IVE group and 2 cases of them had massive bleeding, while in HVE group hepatic veins rupture occurred in 5 cases but no massive bleeding occurred. Intra-operative blood loss was significantly less in HVE group than IVE group. The serum ALT value in postoperative day 1 and total bilirubin in postoperative day 3 in HVE group was significantly lower than that of the IVE group. The mean drainage volume in HVE group was significantly less than that of the IVE group on postoperative day 1 and day 2. The total cost of patient in HVE group were significant less than in IVE group. Conclusions The use of hepatic vein exclusion reduces the risk in the resection of giant hepatic hemangioma near the second hepatic hilum.     

选择性出入肝血流阻断用于肝脏巨大血管瘤的切除

目的 探讨右肝静脉阻断技术在累及第二肝门巨大肝血管瘤切除术中防止右肝静脉破裂大出血、空气栓塞的作用.方法 回顾分析2004年1月至2010年3月浙江省人民医院肝胆外科对12例累及第二肝门巨大肝血管瘤患者施行右肝静脉阻断技术行巨大肝血管瘤切除的临床资料.右肝静脉阻断方法采用血管带阻断或血管夹夹闭.无肝硬化患者同时采用第一肝门阻断(Pringle),或选择性入肝血流阻断;有肝硬化患者采用半肝入肝血流阻断.结果 12例患者中无1例分破肝静脉.右肝静脉血管阻断方法:血管夹夹闭法3例,血管带阻断法9例.11例无肝硬化患者行第一肝门阻断5例,6例行选择性入肝血流阻断,1例患者由于肝炎后肝硬化施行交替半肝血流阻断.12例患者血管瘤切除顺利,出血量200～5800 ml,平均出血量680 ml,其中3例患者未输血.出血量最大1例为肝动脉栓塞治疗2次的患者,血管瘤与隔肌粘连紧密,侧支循环丰富,解剖困难.无1例因肝静脉破裂而出血或发生空气栓塞.结论 切除累及第二肝门巨大肝血管瘤时施行右肝静脉阻断技术是安全,有效的.

Abstract：

Objective To evaluate right hepatic veins exclusion in the prevention of massive bleeding and air embolism during the resection of huge hepatic cavernous hemangioma near the second hepatic portal. Method This is a retrospective study on the clinical data of 12 hepatic hemangioma patients at the Live Surgery Department of Zhejiang Provincial People's Hospital from 2004. 1 to 2010.3. In all patients the huge hepatic cavernous hemangioma was adjoining the second hepatic portal. Block webbing or vascular clamp were used to exclude the right hepatic veins. Among the 11 patients without hepatic cirrhosis Pringle maneuvre was applied in 5 cases and selective hepatic inflow occlusion in 6 cases. Patients with hepatic cirrhosis used hemi-hepatic blood inflow occlusion. Results During the surgery no rupture of right hepatic vein happened. Nine patients used vascular block webbing and 3 patients used vascular clamp.Six patients without cirrhosis used the complete hepatic inflow occlusion and other patients without cirrhosis used hemi-hepatic blood inflow occlusion. Cirrhotic patients used hemi-hepatic blood inflow occlusion. All the operations were successful. Intraoperative blood loss ranged from 200 - 5800 ml, averaging 680 ml. Three patients needed not blood transfusion. There was no right hepatic vein rupture or air embolism. Conclusion Right hepatic veins exclusion is a useful technique to prevent massive bleeding and air embolism caused by the rupture of right hepatic vein during the resection of huge hepatic cavernous hemangioma.     

肝切除术治疗肝血管瘤37例分析

目的 探讨肝血管瘤的诊断、手术指征及外科治疗效果.方法 回顾性分析2005年7月至2008年7月我院肝切除术治疗的37例肝血管瘤患者临床资料.所有病例均通过B超、增强CT和(或)MRI明确诊断.手术指征包括:(1)血管瘤直径>5 cm,位于左外叶或边沿部,伴有较明显临床症状;(2)血管瘤直径>10 cm或短期生长迅速.瘤体位于左叶10例,右叶17例,尾叶3例,肝中叶2例,左右叶多发5例.所有病例术前肝功能Child评级均为A级.结果 右半肝切除5例,左半肝切除2例,左外叶切除10例,尾叶切除3例,肝中央叶段切除5例,肝段切除8例,联合肝段切除4例,预防性胆总管切开、T管外引流2例.术中第一肝门阻断28例,阻断时间8～36 min,平均(22.2±14.3)min;全肝血流阻断7例,阻断时间10～40 rain,平均(21.6±12.1)min.术中输血4例,输血量平均为400 ml.所有手术病例过程顺利,切除标本直径5～20 cm,无手术死亡.术后并发症:胸腔积液4例,膈下积液2例.术后病理:37例均为肝海绵状血管瘤.所有病例随访6个月～4年,无复发.结论 在严格把握手术指征的前提下,应用肝切除术治疗肝血管瘤是安全有效的.

Abstract：

Objective To study the diagnosis,surgical indications, and results of surgical treatment for hepatic hemangioma. Methods The data of 37 patients with hepatic hemangioma treated by hepatectomy in our department from July 2005 to July 2008 were analyzed retrospectively. The diagnoses were made by ultrasound, enhanced CT and MRI. Surgical indications included: (1) diameter >5 cm, located at the left lateral section or the lower edge of the liver with symptoms. (2) diameter >10 cm or recent rapid growth. The hemangioma were located in the left liver in 10 patients, right liver in 17, caudate lobe in 3, middle hepatic lobe in 2, multiple tumors in left and right livers in 5.The preoperative liver function was grade A in all patients. Results Five patients underwent right hepatectomy, 2 underwent left hepatectomy, 10 underwent left lateral sectionectomy, 3 underwent caudate lobectomy, 5 underwent central hepatectomy, 8 underwent right anterior sectionectomy, 4 underwent combined hepatic resections and 2 underwent prophylactic exploration of the common bile duct. Pringle's maneuver was applied in 28 patients, and total hepatic vascular exclusion in 7. The occlusion time ranged from 8-36 and 10-40 minutes (average: 22.2±14.3 min and 21.6±12.1 min),respectively. 400 ml of intraoperative blood transfusion was given to 4 patients each. All operations were successfully carried out. The specimens measured 5-20 cm. There was no peri-operative death.The postoperative complications were: pleural effusion (n=4); subphrenic (n=2). Histologic diagnosis confirmed hepatic cavernous hemangioma in all patients. All patients were regularly followed-up (ranged 6 months-4 years), and no recurrence was detected. Conclusion In carefully selected patients, liver resection for hepatic hemangioma is safe and effective.     

肝海绵状血管瘤外科治疗20年的经验与反思

Objective To summarize the experience in surgical treatment of hepatic cavernous hemangioma (HCH). Methods The clinical data of 345 patients who received HCH resection in General Hospital of PLA from 1986 to 2005 were retrospectively analyzed. Results The ratio between male and female patients was 1/1.8. Eighteen patients (5.2%) were incidentally found with HCH during or after operation. Most of the HCH were located in the right lobe, with the proportion of 16.2% (56/345). Ninety-one patients (26.5%) had small HCH (diameter<5.0 cm), 173 (50.3%) had large HCH (diameter ranging from 5.0-10.0 cm), and 80 (23.2%) had giant HCH (diameter>10.0 cm). The mean diameter of the HCH was (8.0±5.0) cm. Three hundred and twenty-three (99.7%) patients were with Child pugh A. Right subcostal incision and enucleation were performed on all patients. The incidence of postoperative complications and mortality were 11.3% (39/345) and 0.3% (1/345), respectively. Caudate lobe resection was performed on 9 of 11 patients with the tumor located in caudate lobe. Conclusions Some HCHs may be easy to be misdiagnosed as hepatic solid tumor. HCH resection (inclu-ding hepatic caudate lobectomy) is safe for patients with HCH, and the most severe operative complication is massive bleeding during hepatectomy.     

肝海绵状血管瘤外科治疗20年的经验与反思

Objective To summarize the experience in surgical treatment of hepatic cavernous hemangioma (HCH). Methods The clinical data of 345 patients who received HCH resection in General Hospital of PLA from 1986 to 2005 were retrospectively analyzed. Results The ratio between male and female patients was 1/1.8. Eighteen patients (5.2%) were incidentally found with HCH during or after operation. Most of the HCH were located in the right lobe, with the proportion of 16.2% (56/345). Ninety-one patients (26.5%) had small HCH (diameter<5.0 cm), 173 (50.3%) had large HCH (diameter ranging from 5.0-10.0 cm), and 80 (23.2%) had giant HCH (diameter>10.0 cm). The mean diameter of the HCH was (8.0±5.0) cm. Three hundred and twenty-three (99.7%) patients were with Child pugh A. Right subcostal incision and enucleation were performed on all patients. The incidence of postoperative complications and mortality were 11.3% (39/345) and 0.3% (1/345), respectively. Caudate lobe resection was performed on 9 of 11 patients with the tumor located in caudate lobe. Conclusions Some HCHs may be easy to be misdiagnosed as hepatic solid tumor. HCH resection (inclu-ding hepatic caudate lobectomy) is safe for patients with HCH, and the most severe operative complication is massive bleeding during hepatectomy.     

肝海绵状血管瘤外科治疗20年的经验与反思

Objective To summarize the experience in surgical treatment of hepatic cavernous hemangioma (HCH). Methods The clinical data of 345 patients who received HCH resection in General Hospital of PLA from 1986 to 2005 were retrospectively analyzed. Results The ratio between male and female patients was 1/1.8. Eighteen patients (5.2%) were incidentally found with HCH during or after operation. Most of the HCH were located in the right lobe, with the proportion of 16.2% (56/345). Ninety-one patients (26.5%) had small HCH (diameter<5.0 cm), 173 (50.3%) had large HCH (diameter ranging from 5.0-10.0 cm), and 80 (23.2%) had giant HCH (diameter>10.0 cm). The mean diameter of the HCH was (8.0±5.0) cm. Three hundred and twenty-three (99.7%) patients were with Child pugh A. Right subcostal incision and enucleation were performed on all patients. The incidence of postoperative complications and mortality were 11.3% (39/345) and 0.3% (1/345), respectively. Caudate lobe resection was performed on 9 of 11 patients with the tumor located in caudate lobe. Conclusions Some HCHs may be easy to be misdiagnosed as hepatic solid tumor. HCH resection (inclu-ding hepatic caudate lobectomy) is safe for patients with HCH, and the most severe operative complication is massive bleeding during hepatectomy.     

射频凝固器在肝切除术中的应用

目的 评价射频凝固器(Habib 4X)在肝切除术中的应用价值.方法 回顾性分析2009年11月至2010年4月天津市第三中心医院应用Habib 4X对21例肝胆疾病患者施行肝切除术的临床效果.结果 成功完成21例肝切除术,其中右半肝切除3例,左半肝切除1例,2个肝段以上切除9例,单一肝段切除7例,肝脏局部切除1例.肿瘤均完整切除.平均切除时间(50±25)min,平均出血量(129±117)ml.术后无患者进入ICU.术后患者发生胆汁漏3例,淋巴液漏1例,胸腔积液4例,均经非手术治疗痊愈.全组患者无术后腹腔内出血、肝功能衰竭、伤口感染和围手术期死亡.术后平均住院时间(19±14)d.结论 肝切除术中应用Habib 4X辅助切肝,其射频能量可使拟切除面肝组织脱水凝固,闭合局部血管及其他管道系统,不阻断入肝血流,无需预先处理将要离断的粗大血管,可明显减少切除过程中的出血甚至不出血,降低术后并发症的发生率,使肝切除过程更安全、快捷.

Abstract：

Objective To investigate the value of Habib 4X in hepatic resection. Methods The clinical outcome of 21 patients with liver disease who received liver resection at the Tianjin Third Central Hospital from November 2009 to April 2010 were retrospectively evaluated. All the operations were carried out by using Habib 4X. Results All patients received hepatectomy, including right hepatectomy in three patients, left hepatectomy in one patient, multiple segmentectomy in nine patients, single segmentectomy in seven patients and partial liver resection in one patient. All tumors were reseeted completely. The mean operation time was (50±25) minutes and the mean blood loss was(129±117)ml. No patient was transferred to ICU. Three patients were complicated with bile leakage, one with lymphatic leakage and four with pleural effusion, and they were cured by non-surgical treatment. There were no patients with postoperative hemorrhage, incision infection or hepatic failure. No mortality was observed. The mean postoperative hospital stay was(19±14)days. Conclusions Radiofrequency energy was applied along the margins of the tumor to create zones of necrosis before resection with a scalpel, offering hepatobiliary surgeons an additional method for performing liver resections with minimal blood loss, low morbidity and mortality rates. As for malignant tumors, minor or major liver resection assisted by Habib 4X is safe, and it can reduce the chance of positive incisal margin.     

肝海绵状血管瘤外科治疗20年的经验与反思

Objective To summarize the experience in surgical treatment of hepatic cavernous hemangioma (HCH). Methods The clinical data of 345 patients who received HCH resection in General Hospital of PLA from 1986 to 2005 were retrospectively analyzed. Results The ratio between male and female patients was 1/1.8. Eighteen patients (5.2%) were incidentally found with HCH during or after operation. Most of the HCH were located in the right lobe, with the proportion of 16.2% (56/345). Ninety-one patients (26.5%) had small HCH (diameter<5.0 cm), 173 (50.3%) had large HCH (diameter ranging from 5.0-10.0 cm), and 80 (23.2%) had giant HCH (diameter>10.0 cm). The mean diameter of the HCH was (8.0±5.0) cm. Three hundred and twenty-three (99.7%) patients were with Child pugh A. Right subcostal incision and enucleation were performed on all patients. The incidence of postoperative complications and mortality were 11.3% (39/345) and 0.3% (1/345), respectively. Caudate lobe resection was performed on 9 of 11 patients with the tumor located in caudate lobe. Conclusions Some HCHs may be easy to be misdiagnosed as hepatic solid tumor. HCH resection (inclu-ding hepatic caudate lobectomy) is safe for patients with HCH, and the most severe operative complication is massive bleeding during hepatectomy.     

腹腔镜肝血管瘤剥除术的临床应用

目的分析腹腔镜肝血管瘤剥除术在临床应用中的可行性和安全性,提出腹腔镜肝血管瘤剥除术的技术规范。方法回顾性分析2015年11月至2019年2月在河北医科大学第二医院肝胆外科行腹腔镜肝血管瘤剥除术的82例临床资料。结果82例手术均顺利完成,无中转开腹,无术后出血、胆瘘及死亡等严重并发症的发生;手术时间(118.2±46.5)min;肝门阻断时间(30.4±16.2)min,其中肝脏2段、3段血管瘤20例,未行肝门阻断;行肝门阻断后,肝功能指标有所升高,术后5 d内肝功能恢复到术前水平;术中出血(292.1±78.1)ml;手术创面旁常规放置引流管,术后拔除引流管时间1~3 d;术后第1天下地活动,第2天进流食,住院时间(5.7±1.4)d。结论术中合理应用第一肝门阻断技术及肝脏牵拉悬吊技术,利用超声刀及双极电凝处理手术创面,腹腔镜肝血管瘤剥除术的临床应用安全、可行,值得在临床上推广。     

腹腔镜肝切除术治疗肝血管瘤22例临床分析

目的 探讨腹腔镜肝切除术治疗肝血管瘤的技术要点和疗效.方法 回顾分析第三军医大学西南医院2007年3月1日至2008年2月29日22例肝血管瘤病人行腹腔镜肝切除术的临床资料.结果 22例中2例中转开腹,20例完成全腹腔镜肝切除术.规则性肝叶(段)切除14例,其中左半肝切除5例,左外叶切除5例(其中1例联合右肝血管瘤射频消融术),Ⅵ段切除4例;不规则肝切除8例.10例在区域性半肝血流阻断条件下手术,7例行间歇性第一肝门血流阻断,5例未行人肝血流阻断.平均手术时间209 min,平均术中出血量360 ml.全组无手术死亡及并发症发生.术后恢复顺利,平均术后住院时间6 d.随访2～14个月,无症状再发及肿瘤复发.结论 腹腔镜肝切除术治疗肝血管瘤具有手术安全、并发症少和术后恢复快等优点,其技术要点是选择恰当适应证和手术入路,有效控制入肝血流和妥善处理肝断面,肝实质离断沿瘤体周围0.5～1 cm正常肝实质内进行或直接行荷瘤肝叶(段)规则性切除.     

改良的完全腹腔镜肝血管瘤切除10例

目的：探讨改良的完全腹腔镜肝切除的手术技巧和改良方法。方法回顾分析2009年5月-2013年1月在扬州大学临床医学院完成的10例改良的完全腹腔镜肝切除术治疗血管瘤患者的临床资料。结果本组10例均成功完成了改良的完全腹腔镜肝血管瘤切除术,无中转开腹手术（其中1例联合腹腔镜胆囊切除术）。手术时间125-185 min,平均149.5±18.8 min,术中出血量220-450 ml,平均330±71.8 ml,腹腔引流管放置时间3-10 d,其中1例术后第3天出现胆漏,余病例未发生胆漏、出血、感染等并发症。术后住院5-12 d,平均8.4±2.3 d。术后病理证实均为肝海绵状血管瘤。结论完全腹腔镜肝切除术是安全可行的,腹腔镜下预置自制的第一肝门阻断器的办法有效控制入肝血流和妥善处理肝断面;改良的标本取出方法使得肝脏良性病变能够真正做到完全腹腔镜下进行手术,将腹腔镜手术的创伤减少到最低,值得临床推广应用。     

改良腹腔镜下射频消融术治疗巨大肝血管瘤21例

目的探讨改良的腹腔镜下射频消融术(RFA)治疗巨大肝脏血管瘤的可行性及疗效。方法回顾性分析2014年6月至2016年6月改良的腹腔镜下RFA治疗21例患者的24个巨大肝血管瘤病灶。应用SPSS19.0统计学软件分析,术后1、6个月瘤体平均直径、RFA时间、平均住院时间以x珋±s表示,采用t检验,P0.05差异有统计学意义。结果 24个巨大肝血管瘤病灶均在腹腔镜下顺利完成手术。术中未肝门阻断,平均射频消融时间(8±4.6)min,术中平均出血量(10±5.6)ml。术后平均住院时间为(8.5±3.6)d,术后无胆瘘、出血及其他严重并发症。术后1个月复查超声造影,瘤体平均直径(3.5±1.6)cm,18个血管瘤病灶完全无残留血液供应,6个病灶少许残留血液供应,分别位于肝Ⅶ3个及肝Ⅷ3个。术后6个月复查超声造影,瘤体直径及血流情况同术后1个月复查结果。结论改良的腹腔镜下RFA治疗巨大肝血管瘤安全可行,疗效满意。     

腹腔镜肝切除治疗肝血管瘤的临床分析

【摘要】〓目的〓探讨腹腔镜肝切除治疗肝血管瘤的可行性和疗效。方法〓回顾性分析2011年1月1日至2012年12月31日中山大学孙逸仙纪念医院肝胆外科实施的18例腹腔镜肝切除术治疗肝血管瘤病例的临床资料。结果〓18例患者均应用腹腔镜完成手术。肝血管瘤平均直径为7.6(5.5~14)cm,手术时间为(121±44)min。13例患者术中选择性半肝阻断,术中平均出血量283(60~900)mL,术后平均住院时间8(6~12)d。术后病理均证实为海绵状血管瘤。术后1例患者并发胸腔积液,经保守治疗痊愈。 结论〓选择合适的病例,掌握半肝血流阻断技术,选择正确的肝实质离断平面,合理应用离断肝实质器械,腹腔镜肝血管瘤手术是安全可行的。     

腹腔镜规则性左肝外侧叶切除术10例分析

目的:总结腹腔镜左肝外侧叶切除术经验。方法:2004年12月至今我们共完成10例完全腹腔镜下规则性左肝外侧叶切除术,其中原发性肝细胞癌6例,肝血管瘤2例,结肠癌肝转移2例。结果:10例均在完全腹腔镜下成功完成规则性左肝外侧叶切除,平均手术时间100m in,平均术中出血量少于100m l,术后腹腔引流管放置3~4d,术后平均住院5d,术后无出血及胆漏并发症。结论:腹腔镜规则性左肝外侧叶切除可作为左肝外侧叶切除术的金标准。     

腹腔镜与开腹肝血管瘤切除术对患者术后恢复的影响分析

目的探讨腹腔镜肝血管瘤切除术与开腹手术对患者术后恢复疗效。方法将56例肝血管瘤患者随机分为腹腔镜组和开腹组,每组28例。比较两组患者术中资料和术后恢复情况。应用SPSS 20.0软件包进行数据处理,手术时间、术中出血量、术中输血量、切口长度、ALT水平、AST水平、术后输血量、术后引流量及住院天数等计量资料以(x珋±s)表示,采用t检验;并发症发生率等计数资料采用χ2检验或Fisher检验。P0.05为差异具有统计学意义。结果腹腔镜组患者切口长度(6.4±0.6)cm、术中流血量(132.3±25.8)ml和术中输血量(104.3±15.6)ml与开腹组[分别为(24.5±4.7)cm、(245.6±36.2)ml、(211.5±22.8)ml]比较差异具有统计学意义(t=20.214,13.487,20.533,P0.01)。腹腔镜组患者术后输血量(402.5±45.3)ml、引流量(244.6±35.2)ml、住院天数(9.4±1.5)d和并发症发生率(14.3%)显著低于开腹组[(588.6±67.1)ml、(335.1±38.1)ml、(12.8±2.1)d、39.3%]差异具有统计学意义(t=12.163,t=9.232,t=6.971,P0.01)。腹腔镜组术后并发症4例(14.3%)明显低于开腹组11例(39.3%),差异具有统计学意义(χ2=4.462,P0.05)。结论腹腔镜肝血管瘤切除术治疗肝血管瘤术中损伤较小、患者术后肝功能和其他生理指标恢复更快具有临床应用价值。     

腹腔镜右肝肿瘤切除术的初步探讨(附15例报告)

目的:探讨腹腔镜右肝肿瘤切除术的可行性、安全性。方法:回顾分析2012年9月至2014年2月为15例右肝肿瘤患者行腹腔镜肝切除术的临床资料。其中肝血管瘤9例,原发性肝癌6例。结果:12例成功完成完全腹腔镜下手术,3例行手辅助腹腔镜手术,无一例中转开腹。其中10例行肝右后叶切除术,5例行右前叶肿瘤切除术。术中13例需阻断肝门,阻断时间平均(17.3±3.5)min。手术时间平均(150±55)min,术中出血量平均(168±39)ml,术后平均住院(11.2±2.7)d。结论:腹腔镜右肝肿瘤切除术受技术问题、手术风险性、肿瘤治疗原则的限制,对术者腹腔镜技术要求较高,操作过程复杂,但在严格把握手术适应证、熟练掌握腹腔镜技术的前提下,肝右叶的肿瘤行腹腔镜肝肿瘤切除术是安全、可行的。     

腹腔镜规则性肝左外叶切除的临床应用暨文献复习

目的探讨腹腔镜规则性肝左外叶切除的安全性和有效性。方法腹腔镜下行规则性肝左外叶切除7例,其中肝左外叶巨大囊肿4例、肝左外叶巨大血管瘤1例、肝左外叶肝细胞癌1例、肝左外叶慢性化脓性炎1例。结果 7例患者均成功在腹腔镜下施行了规则性肝左外叶切除术,无中转开腹,手术时间(148.6±79.5)min,术中出血(280.0±218.4)ml,术后胃肠功能恢复(2.6±1.5)d,术后住院(9.1±4.7)d,均无胆漏、出血、腹水、感染、空气栓塞等并发症发生。结论在掌握手术适应证、精心的病例选择及具备丰富的腹腔镜操作经验的基础上,腹腔镜规则性肝左外叶切除是安全、有效的,可充分发挥腹腔镜技术的微创优势。