腹腔镜左半肝切除术4例报告

目的探讨应用腹腔镜手术完成左半肝切除的可行性。方法腹部trocar的放置同LC,惟剑突下trocar的置放稍偏向左侧。CO2气腹压力10-12mm Hg,超声刀切断镰状韧带、冠状韧带、左三角韧带,切除胆囊。肝门血流阻断方式分别选择不阻断1例、间歇阻断1例、选择性阻断2例,胆囊窝中点至肝门左侧方向,应用超声吸引刀（Cavitron Ultrasonic Surgical Aspirator,CUSA）、电凝等器械向肝实质内分离至肝门左侧方。解剖左肝管、左门静脉横部后,将其分别结扎切断。肝内分离结扎切断肝左静脉,切除左半肝。结果3例左肝管狭窄结石合并继发左肝叶纤维化,肝脏分离过程仅有少量出血,电凝止血效果良好。1例肝血管瘤,病变位于左外叶及左内叶上段,仅于显露结扎切断左肝静脉时出现小量活跃出血,予以缝合止血。4例手术时间分别为390、255、384、330min,术中出血量分别为360、500、370、280ml。术后3-6个月随访：3例左肝管狭窄结石胆道镜检查肝内外胆管正常,1例肝血管瘤一般状态良好,恢复正常生活,体重增加3kg。结论腹腔镜左半肝切除术可行,术后恢复快,但行此类手术应慎重,一要具备相应的设备器械,二要有开腹肝切除和腹腔镜手术经验的医师行此手术。

Laparoscopic Left Hepatectomy: Report of 4 Cases

Objective To investigate the feasibility of laparoscopic left hepatectomy.Methods One trocar was put at the abdominal wall as in laparoscopic cholecystectomy,while the trocar under the xiphoid was at the left to the middle line.Under CO2 pneumoperitoneum（10-12 mm Hg）,the falciform ligament,coronary ligament,left triangular ligament,and then the gallbladder were cut by ultrasonic scalpel.Discontinued obstruction and selective obstruction of the liver bloodstream were employed in one and two cases respectively,in the other case,no obstruction was carried out.By using CUSA（Cavitron Ultrasonic Surgical Aspirator）or electric coagulation,the liver parenchyma was separated from the midpoint of fossa of the gallbladder to expose the left hepatic portal.Afterwards,the left hepatic duct,pars transversa were cut and then ligated,and the left hepatic artery was cut and ligated to remove the left liver.Results In this series,three patients had stenosis of the left hepatic duct stones complicated with fibrosis of the left liver,during the operation,a little blood loss was revealed when separating the liver,and was controlled by electrocoagulation.In one case of hepatic hemangioma,which was located at the left lateral lobe and the upper segment of the left medial lobe,active bleeding with a small volume was found when the left liver vein was cut,and then was stopped by suturing.The operation time was 390,255,384,and 330 minutes respectively in the four cases.And the intraoperative blood loss was 360,500,370 and 280 ml respectively.The patients were followed up for 3 to 6 months,during which,cholangioscopy showed normal external and internal hepatic ducts in the three cases of stenosis and stones of the left hepatic duct;the patient with hepatic hemangioma showed good general condition,had normal daily life,and increased body weight（by 3 kg）.Conclusions Laparoscopy is feasible for left hepatectomy.Patients recover quickly after the procedure.Experience in open hepatectomy and laparoscopy are necessary for this operation.