选择性小切口肝切除的应用

目的介绍小切口肝切除的应用方法与体会。方法2006年1月至2007年1月，23例患者行小切口肝切除，其中男15例，女8例，年龄21～63岁，平均（46．28±7．25）岁。术前肝功能Child—Pugh分级A级18例，B级5例。手术采用右侧肋缘下小切口入腹，应用拉钩暴露术野，采用Biclamp和Ligasure离断肝脏。结果23例患者均在预定小切口下完成手术，切口长度6～11（8．20±1．12）cm，手术时间（158．67±47．71）min，出血量50～400ml，平均（389．52±201．43）ml，术中未发生不能控制的出血。术后平均住院13为（6．81±1．89）d。腹水1例，经保守治疗控制。无其他并发症及死亡。结论对于特定的病例，经过术前影像学评估和设计，采用小切口进行肝切除，可以减少手术创伤和并发症。

Practice and evocation of mini-incision hepatectomy

Objective To introduce the methods and experience of mini -incision hepatectomy. Methods During Jan. 2006 to Jan. 2007,23 cases were cured by mini - incision bepatectomy, including 15 men and 8 women with the age of 46.28 ± 7.25 years old （range： 21 -63 ）. Eighteen cases were categoried into＂ Class A＂of Child- Pugh classification and 5 cases＂ Class B＂. By an approach to the abdominal cavity through right subeostal incision, a retractor was used to expose operating field, and Biclamp and Ligasure to transect liver parenchyma. Results The operation was successfully done via mini- incision hepatectomy in all the 23 cases. The incision length was （8.20±1.12） cm （rang： 6 - 11 ）, the operative time was （ 158.67 ± 47.71 ） min, the blood loss was （ 389.52 ± 201.43 ） ml （ range ： 50 - 400 ）. No uncontrollable bleeding occurred during operation. The postoperative hospital stay was （6.81 ± 1.89） days, ascites occurred in 1 case cured by conservative treatment. Conclusion In selected patients ,throught pre -operation imaging evaluating and designing, hepatectomy can be completed via mini - incision which could reduce surgical trauma and the occurrence of complications.