经腹腔镜左肝切除五例

目的 探讨腹腔镜解剖性左肝切除手术的临床经验。方法 经临床筛选病灶位于左半肝的病例5例，其中原发性肝癌3例、肝囊肿伴感染1例、肝血管瘤1例。应用电刀、超声刀和腔内直线形切割缝合器等多种断肝方法，采用钛夹夹闭、医用生物蛋白胶粘封等肝断面处理方法，在全气腹条件下经腹腔镜行左半肝切除2例，左外叶切除2例，肝方叶切除1例。结果 5例均在腹腔镜下完成肝切除手术，对各肝段的脉管先进行解剖分离，然后进行处理是手术控制出血的关键。使用垃圾袋将标本取出。术中未出现不能控制的并发症，腹腔引流管放置时间2～4d。术后未发生胆漏和出血等并发症，恢复顺利，术后平均住院7d，术后恢复时间较常规开腹方法肝切除病人明显缩短。结论 对位于左半肝的病灶，采用多种方法相结合行腹腔镜解剖性左肝切除手术是安全可行的手术方式，特别是创伤小的优点给伴有严重肝硬化而不能耐受开腹手术者提供了切除肿瘤的新途径。

Laparoscopic anatomical resection of left liver in 5 cases

Objective To determine how to manage laparoscopic anatomical resection of the left liver. Methods Candidates for laparoscopic anatomical resection were 5 cases of liver neoplasms including 3 of primary liver cancer, 1 of infected liver cyst and 1 of liver hemangioma. Electric-cautery, ultracision and endo-cutter were used for liver transection. Operative procedures included left hepatectomy in 2 cases, left lobectomy in 2 and segment-4 resection in 1. Results Laparoscopic anatomical resection of the left liver was successfully conducted in all the 5 cases. The key procedure was anatomical dissection of hepatic vessels followed by clips and transection. The operative duration was 190-320 min. The average postoperative hospital stay was 7 d. The blood loss during the operation was 200- 1 000 ml. No complication occurred. Conclusions Laparoscopic anatomical resection of the left liver is a prospective and minimally invasive technique that can be carried out safely and effectively to result in reduction of postoperative pain and hospital stay.