腹腔镜规则性左肝外侧叶切除术15例

目的探讨腹腔镜左肝外侧叶切除术的可行性。方法2004年12月-2006年8月对病灶位于左肝外侧叶原发性肝细胞癌10例，肝海绵状血管瘤3例，结肠癌肝转移2例，腹腔镜下应用电刀或超声刀、线性切割器等切除左肝外侧叶。结果15例均在完全腹腔镜下行规则性左肝外侧叶切除，无中转开腹。手术时间65—120rain，平均100min；术中出血量50—100ml，平均80ml。肿瘤全部完整切除，无破裂，完整取出标本的边界距肿瘤切缘1cm以上，术后病理证实切端未见癌细胞侵犯。术后无出血及胆漏，术后腹腔引流管3—4d。术后住院3—5d。12例肝癌术后随访1-20个月，平均12．5月，未见肝内复发及手术切口肿瘤种植，所有患者均健康存活。结论腹腔镜规则性左肝外侧叶切除可行、安全。

Laparoscopic regular hepatic left lateral lobectomy: A report of 15 cases

Objective To evaluate the safety and feasibility of laparoscopic hepatic left lateral lobectomy. Methods Clinical data of 15 patients from December 2004 to August 2006 were analyzed, including 10 cases of hepatocellular carcinoma, 3 cases of hepatic hemangioma, and 2 cases of metastatic liver carcinoma from colorectal carcinoma. Tumors were all located at the left lateral lobe. Under laparoscopy, the ultrasonic dissection, electrocautery, or Endo-GIA ligation were utilized to perform regular hepatic lobectomy. Results Laparoscopic hepatectomy was uneventfully accomplished in all the 15 patients, without conversions to open surgery. The operation time was 65~120 min (mean, 100 min), and the intraoperative blood loss was 50~100 ml (mean, 80 ml). The lesions were entirely resected with a resection margin > 1 cm. Postoperative pathological findings showed negative cut surface. No hemorrhage or bile leakage were seen after operation. The abdominal drainage tube was indwelled for 3~4 d. The postoperative hospital stay was 3~5 d. Follow-up checkups for 1~20 months (mean, 12.5 months) revealed no tumor recurrence or incision implantation. All the patients survived. Conclusions Laparoscopic regular hepatic left lateral lobectomy can be carried out safely and effectively in clinically selected patients.