腹腔镜肝切除手术技巧

目的探讨腹腔镜复杂肝切除手术技巧并评价其临床疗效。方法本研究利用腹腔镜下易于建立隧道的特点,通过在肝实质内重要管道附近建立隧道,快速安全地离断肝实质,从而提高手术安全性,回顾性分析自2014年9月至2016年6月在华中科技大学同济医学院附属协和医院肝胆外科实施52例腹腔镜规则性肝切除病人的临床资料,分析平均手术时间、术中出血量、术后住院时间和并发症发生率等指标。结果所有病人均顺利完成手术,无中转开腹及围手术期死亡,右半肝切除平均手术时间为(220±45)min,术中出血量为(210±92)ml;肝段切除手术时间为(100±35)min,术中出血量为(300±130)ml;术后平均住院时间为(11±2)d,1例病人术后发生胆漏,并发症发生率为1.9%。结论通过在肝实质内重要管道附近建立隧道可以安全快速地完成腹腔镜下复杂肝切除术,降低术中出血风险,是一种简便易行且安全可行的手术方式,值得临床推广。

The surgical technique of laparoscopic hepatectomy

Objective To evaluate the surgical technique and clinical effect of laparoscopic hepatectomy.Methods The liver parenchyma dissection can be performed easily and safely by building tunnels aside vital ducts with the advantage of laparoscopy in building tunnels.The clinical data of 52 patients who underwent laparoscopic hepatectomy from Sep.2014 to June 2016 were retrospectively.The mean operative time,intraoperative blood loss,postoperative hospital stay and complication rate were analyzed.Results All the operations were completed successfully,and there was no perioperative death or conversion to laparotomy.The mean operative time for right hemihepatectomy was 220 ± 45 min,and intraoperative blood loss was 210 ± 92 mL.The mean operative time for hepatic segmentectomy was 100 ± 35 min,and intraoperative blood loss was 300 ± 130 mL.The postoperative hospital stay was 11 ± 2 days.One patient experienced biliary leakage and the complication rate was 1.9％.Conclusions Laparoscopic hepatectomy by building tunnels aside vital ducts can reduce the risk of intraoperative bleeding,and it is feasible and safe,which is worth to be spread