3D腹腔镜肝切除术在肝泡型包虫病中的应用

目的分析3D腹腔镜肝切除术(three dimension－laparoscopic hepatectomy,3D－LH)治疗肝泡型包虫病(hepatic alveolar echinococcosis,HAE)的优势及技术要点,为保证手术安全、高效完成,以及促进该手术方式在HAE临床手术治疗中的应用和推广提供参考。 方法回顾性收集并分析新疆医科大学第一附属医院肝胆包虫科2017年1月至2018年6月行3D－LH的8例HAE患者临床资料,记录手术时间、术中出血量、腹腔引流管留置时间、术后住院时间及并发症发生情况。 结果8例患者均成功实施3D－LH,其中腹腔镜右半肝切除术4例、左半肝切除术1例、肝段切除术3例,手术时间(327±86)min,术中出血量(421±654)ml,腹腔引流管留置时间(4.6±1.5)d,术后住院时间(6.9±2.7)d;其中1例患者术中出血量较多给予输注悬浮红细胞,1例患者术后并发胸腔积液;所有患者均于术后好转出院。 结论3D－LH在HAE中的应用是安全的、可行的,具有精准、微创等优势,值得在临床推广和应用,而术中有效控制出血及避免副损伤是保障手术成功实施的关键。

Value of 3D laparoscopic hepatectomy for hepatic alveolar echinococcosis

ObjectiveTo analyze the advantages and technical points of 3D laparoscopic hepatectomy in the treatment of hepatic alveolar echinococcosis, in order to ensure the safety and efficiency of the operation and promote the application of the operation in the clinical hepatic alveolar echinococcosis. MethodsThe clinical data of 8 patients with hepatic alveolar echinococcosis who underwent 3D laparoscopic hepatectomy from Jan. 2017 to Jun. 2018 in the Department of Hepatobiliary Echinococcosis, the First Affiliated Hospital of Xinjiang Medical University were collected and analyzed retrospectively, and the operation time, intraoperative bleeding volume, placement time of abdominal drainage tube, postoperative hospitalization time and complications were observed. Results8 patients were successfully performed 3D laparoscopic hepatectomy, including 4 cases of laparoscopic right hepatectomy, 1 case of left hepatectomy, 3 cases of segmental hepatectomy. The operation time was (327±86) min, intraoperative bleeding volume (421±654) ml, placement time of abdominal drainage tube (4.6±1.5) d, postoperative hospital stay (6.9±2.7) d, more intraoperative bleeding volume of 1 patient was infused with suspension red blood cells, 1 patien developed pleural effusion. All patients were discharged after operation. Conclusionsthe application of 3D laparoscopic hepatectomy in hepatic alveolar echinococcosis is safe, feasible, accurate and minimally invasive, which is worth clinical promotion and application. The key to ensure the successful implementation of the operation is to effectively control bleeding and avoid side injury.