腹腔镜肝切除术的常见并发症及其防治

目的 总结和探讨腹腔镜肝切除患者常见并发症的预防及治疗.方法 回顾性分析了2005年5月至2013年5月开展的160例腹腔镜肝切除手术病例的临床资料.其中肝癌122例,肝良性肿瘤23例,肝内胆管结石15例.合并肝硬化者85例.腹腔镜肝左外叶切除术47例,腹腔镜左半肝切除术18例,右半肝切除术7例,肝段切除33例,局部肝切除术40例.结果 中转开腹术15例.术中门静脉右支损伤1例,门静脉主干损伤1例,肝左静脉损伤1例.术后肝断面出血6例,胆瘘5例,腹水9例,胸腔积液6例,肺部感染5例,除1例肝癌患者因肝功能衰竭死亡外,其余均痊愈出院.结论 腹腔镜肝切除的并发症应重在预防,通过准确的术前评估,充分的术前准备,熟练的腔镜下操作,严格的术后管理可以大幅降低腹腔镜肝切除的并发症.

Prevention and treatment of complications in laparoscopic hepatectomy

Objective To summarize and analyze prevention and treatment of complications in laparoscopic hepatectomy.Methods A retrospective analysis was conducted in our department from May 2005 to May 2013 over 160 patients who underwent hepatectomy according to their clinical data There were 122 cases of liver cancer,23 cases of liver benign,and 15 cases of bile hepatolithiasis.Eight-five cases were associated with cirrhosis.The types for laparoscopic hepatectomy included left lateral sectionectomy （n-47）,left hepatectomy （n-18）,right hepatectomy （n-7）,segment hepa tectomy （n-33）,and local resection （n-40）.Results Fifty cases were converted laparotomy.Dur ing operation,portal vein injury occurred in 1 case,right branch injury in 1 case,left hepatic vein inju ry in 1 case,bleeding in 6 cases,bile leakage in 5 cases,abdominal cavity effusion in 9 cases,pleural effusion in 6 cases,and pulmonary infection in 5 cases.Except for one death due to liver failure after laparoscopic hepatectomy,the remaining patients were cured and discharged.Conclusions Complica tions of laparoscopic hepatectomy should focus severely on prevention.The incidence of laparoscopic hepatectomy complications can be significantly reduced with accurate assessment before surgery,suffi cient preparation,skillful laparoscopic operation and strict after surgery management.