手助腹腔镜技术在大肝癌切除中的应用

目的 探讨手助腹腔镜技术在大肝癌切除中的应用价值.方法 2004年3月至2007年12月,在腹腔镜下肝内小病灶切除的基础上共对56例病变位于肝外周部位(Ⅱ～Ⅵ段)的直径大于5 cm大肝癌患者成功施行了手助腹腔镜肝切除术.其中肝细胞癌53例,肝内胆管细胞癌2例,肝转移性鳞癌1例.采用手助腹腔镜技术行规则性左肝叶切除或不规则性右肝切除术.结果 56例手助腹腔镜肝切除均获得成功,肝左外叶切除27例、左半肝切除6例,肝V、Ⅵ段不规则性切除23例.31例行肝门阻断,平均阻断时间为16.7 min,平均手术时间为105.3 min,平均出血量97 ml,瘤体平均大小8.6 cm,切除的肝组织最大径平均10.5 cm,术后无严重并发症发生,术后平均进食时间为2.1 d,术后平均住院7.3 d.结论 在严格掌握患者手术指征的前提下,手助腹腔镜大肝癌切除是安全可行的.

Hand-assisted laparoscopic hepatectomy for large lver cancer in 56 cases

Objective To investigate the practical value of hand-assisted laparoscopic hepatectomy for large liver cancer in peripheral segments.Methods From March 2004 to December 2007,56 patients with large liver cancer underwent hand-assisted laparoscopic hepatectomy including 53 cages of hepatocellular carcinoma,2 cases of cholangiocelluar carcinoma,1 case of hepatic metastatic squamous carcinoma.Results The operation procedures were completed safely in all patients including 27 left lateral segmentectomies,6 left hemihepatectomies and 23 atypical right hepatectomy.Thirty-one cases with hepatic hilum blocking in the procedure and the mean time Wag 16.7 minutes.Mean surgical time wag 105.3 minutes.Mean blood loss Wag 97 ml Mean gross tumor size was 8.6 cm. Mean excisional hepatic tissue volume was 10.5 cm.No serious postoperative complications occurred.Mean eating time was 2.1 days.The mean postoperative hospital stay was 7.3 days.Conclusion Hand-assisted laparoscopic hepatectomy for large liver carcinoma is feasible and safe for selected patients.