完全腹腔镜下肝叶切除术30例

目的探讨完全腹腔镜肝切除(LH)的手术技巧和临床效果。方法回顾性分析2005年5月至2008年3月30例施行LH术患者的临床资料,包括手术时间、术中失血量、术后并发症等。其中,术后病理证实原发性肝癌(PLC)15例,肝血管瘤8例,大肠癌肝转移3例,左肝肝内胆管结石3例,肝脏局限性结节状增生1例,上述肝脏占位病灶大小为3cm×2cm×2cm至11cm×8cm×9cm,标本装入塑料袋剪碎取出。结果 30例患者LH术顺利完成,无中转开腹手术。平均手术耗时168(55~263)min,术中出血量约280(20～1000)ml。2例术后发生胆漏,经充分引流2周治愈;1例合并糖尿病患者出院后1个月出现肝断面感染,脓肿形成,经穿刺引流治愈。平均术后住院时间为9.2(5~18)d。对8例PLC患者术后随访15(6~30)个月,其中1例转移性肝癌术后6个月发生右侧腹壁戳孔种植转移。结论腹腔镜下肝切除术是一种安全、有效、微创的手术,但对恶性肿瘤,应注意种植转移。

Clinical experiences of total laparoscopic hepatectomy: a report of thirty cases

Objective To summarize the surgical skills and clinical efficacy of 30 total laparoscopic hepatectomy（LH）. Methods From May 2005 to March 2008, 30 cases of LH were performed, the data including operating time, blood loss and postoperative complications, etc, were analyzed retrospectively. Of all the patients, the diseases performed LH including primary liver carcinoma（15 cases）, liver hemoangioma（8 cases）, colon carcinoma with liver metastasis（3 cases）, intrahepatic stone（3 cases） and liver focar （1 case）. Results The operation was successful in the 30 patients, mean blood loss was 280（20-1000） ml, mean surgical time was 168（55-263） minutes, mean postoperative hospital day was 9.2（5-18） days. Postoperative complications including two cases of bile leakage, and one case of liver absess occur in one patient with diabebitc. No other serious postoperative complications occurred. The patients with malignant tumor were followed up for 6 to 30 months and there was no local recurrence, but one colon carcinoma case with liver metastasis ocurred implantative metastases in trocar site. Conclusion Laparoscopic hepatectomy is a safe, effective and minimally invasive procedure for selected patients, but implantative metastases should be prevented.