腹腔镜超声技术在腹腔镜肝切除术患者中的应用

目的 探讨腹腔镜超声肝脏检查及在其引导下施行腹腔镜肝切除术的价值.方法 22例腹腔镜肝切除术中应用10 mm 7.5/10 MHz线性超声探头检查肝脏,在腹腔镜和超声波共同引导下,了解切线上肝内管道分布和走行,确定并校正切线,引导腹腔镜肝切除,并了解肿瘤边缘或结石残留情况.结果 应用腹腔镜超声的22例腹腔镜肝切除术中发现1例肝脏意外肿瘤灶1个,21例手术获得成功,其中1例由于肝硬化肝创面出血中转开腹手术.手术时间平均为157 min,腹腔镜超声检查和引导时间平均14 min,术中平均出血量为520 ml.无结石或肿瘤残留.术后出现肝创面胆漏和膈下积液各1例,均经引流后痊愈.结论 腹腔镜超声检查能较准确对腹腔镜肝切除术前后进行评估,在其引导下有助于腹腔镜肝切除术的顺利施行.

Laparoscopic ultrasonography in laparoscopic hepatectomy: experience with 22 cases

OBJECTIVE: To assess the value of laparoscopic ultrasonography in laparoscopic hepatectomy. METHODS: Twenty-two patients with liver diseases underwent laparoscopic ultrasonography. A 10 mm 7.5/10 MHz linear, side viewing laparoscopic ultrasonography probe was used intra-operatively to examine the convergence of intrahepatic biliary ducts and blood vessels, confirm and correct the resection line, guide the laparoscopic resection, examine the tumor margin, and discover the residue of calculi. RESULTS: One additional tumor was detected in one primary liver tumor case during the laparoscopic hepatectomy. Laparoscopic hepatectomy was accomplished successfully in 21 patients one of which had to be transferred to laporotomy due to severe liver cirrhosis and uncontrollable bleeding. The average operation time was 157 min with the average examining and guiding time of 14 min. The intra-operative bleeding amount was 520 ml. No calculus and tumor residue were found. One case of post-operative liver wound bile leakage and one case of subphrenic hydrops were found and they both recovered after drainage. CONCLUSION: Intra-operative laparoscopic ultrasonography helps evaluate the entire liver and decide the resection line accurately. Under its guiding the laparoscopic hepatectomy can be performed smoothly.