完全腹腔镜下原发性肝癌切除32例报告

目的探讨腹腔镜肝癌切除的安全性、可行性和微创性。方法回顾性分析2008年10月—2011年2月行腹腔镜肝癌切除术32例原发性肝癌患者的临床资料。结果 32例患者腹腔镜下肝癌切除术成功,无中转开腹。病灶分别位于Ⅱ段(3例),Ⅲ段(8例),Ⅱ+Ⅲ段(10例),IV段(2例),V段(4例),VI段(5例)。病灶直径1.8～9.2 cm,平均4.3 cm,均为单病灶,均合并肝硬化。术前肝功能Child A级者27例,Child B级5例。术式包括:左半肝切除2例,左外叶切除15例,局部切除15例。术中采用结合超声刀和LigaSure或内镜下切割缝合器(Endo-GIA)联合断肝。2例患者临时阻断第一肝门,时间分别为15,22 min,3例患者术中输红细胞2 U。术后无创面出血及胆瘘等并发症,无肝功能衰竭发生,均痊愈出院。32例随访5～26个月,3例局部复发,无死亡病例。结论腹腔镜肝癌切除是安全、可行的,腹腔镜肝癌切除技术难度大,手术适应证应严格选择,病灶大小和位置是主要的参考指标;超声刀与Ligasure联合断肝止血效果好、解剖结构清晰。

Experience in total-laparoscopic hepatectomy for primary liver cancer: a report of 32 cases

Objective To study the safety,feasibility and minimal invasiveness of laparoscopic hepatectomy for primary liver cancer.Methods The clinical data of 32 patients with primary liver cancer undergoing laparoscopic hepatectomy from October 2008 to February 2011 were retrospectively analyzed.Results Laparoscopic hepatectomies were successfully performed in all patients without convertion to an open surgery.The lesions were located in Couinaud hepatic segment II(n=3),segment III(n=8),segments II and III(n=10),seg...