腹腔镜精准肝切除22例体会

目的总结腹腔镜精准肝切除术的技术要点和效果。方法回顾分析2010年10月～2013年1月间我科22例腹腔镜肝切除术患者的临床资料。结果本组22例中，19例全腔镜下完成精准肝切除：规则性肝叶（段）切除13例，其中左半肝切除1例，左外叶切除8例，Ⅵ段切除4例；不规则切除6例。3例术中中转开腹，其中1例为右半肝切除，另2例为肝Ⅶ段肿瘤切除。术中均未置放肝门阻断带。平均手术时间（190±75）min，平均出血量（320±125）ml，平均住院时间（9．6±2．5）d。全组无手术死亡，2例术后胆漏，1例出现胸腔积液，经引流后治愈。均获随访，时间1—26个月，除1例肝细胞癌术后15月死于复发转移外，其余肝癌尚未复发，良性病变患者无症状再发。结论腹腔镜肝切除术是值得选择的微创手术方式，技术要点是选择恰当的人路，有效控制出入肝血流，精准肝门解剖是确保手术成功的关键，掌握扎实的开腹手术基本功是腔镜手术安全的保障。

Precise Laparoscopic Hepatectomy： 22 Cases Report

Objective To assess the techniques and effects of laparoseopic hepatectomy. Methods The clinical data of 22 cases admitted from October 2010 to January 2013 were analyzed retrospectively. All cases were performed laparoscopic hepatectomy. Results 19 patients received successful total laparoscopic liver resection. Anatomical liver resection was carried out in 13 patients, including 1 with left hemi-hepatectomy, 8 with left lat- eral segrnentectomy and 4 with segment Ⅵ resection. Irregular hepatectomy was performed in 6 patients. 3 cases converted to laparotomy due to hemorrhea, including 1 with right hem-ihepatectomy and 2 with segment Ⅶ resec- tion. All cases were not carried out portal triad clamping. The mean operation time was 190 ± 75 minutes, mean blood loss was 320 ±125 ml, and mean hospital stay was 9.6 ± 2.5 days. No perioperative death occurred. Bile leakage was found in 2 patients and pleural effusion in 1 patient, and were cured by drainage. All patients were followed up for 1 to 26 months. No recurrence was found in patients except 1 death of hepatoeellular carcinoma 15 months after operation. Conclusions The key points of laparoscopic hepatectomy are the right choice of surgi- cal approach and effective control of hepatic blood inflow. The application of selective hemi-hepatic blood occlu- sion technique and proper management of cutting surface of liver are important in ensuring the success of operation and reduction of complications. Precise liver portal dissection is crucial to ensure successful operation. Mastering the basic skills of laparotomy is a guarantee for laparoscopic hepatectomy.