腹腔镜下左肝外叶切除手术方式探讨

目的探讨腹腔镜下左肝外叶切除的方法。方法回顾性分析笔者所在医院2009年10月至2012年12月期间收治的86例肝内外胆管结石及肝血管瘤患者的临床资料。86例患者均行腹腔镜肝切除术,其中经左纵沟左肝外叶切除术49例,经第一肝门左肝外叶切除术37例。比较两种术式的手术时间、术中出血量、术后住院时间及术后并发症发生情况。结果左纵沟组与第一肝门组相比,手术时间缩短〔（142±123）min比（208±58）min〕及术中出血量减少〔（320.5±38.3）mL比（450.9±39.1）mL〕,P〈0.05;但在术后住院时间及术后并发症方面2组间差异无统计学意义（P〉0.05）。结论经左纵沟行腹腔镜下左肝外叶切除术更安全、快捷。

Discussion on Surgical Approach of Laparoscopic Resection of Left Hepatic Lobe

Objective To discussion the surgical approach oflaparoscopic resection of left hepatic lobe. Methods The clinical data of 86 patients with Intr- and extra-hepatic bile duct stones and liver hemangioma were analyzed retros- pectivly. Eighty-six patients underwent laparoscopic hepatectomy. Forty-nine cases underwent the left hepatic lobe resection by the left longitudinal groove （left longitudinal groove group）, 37 cases underwent the left hepatic lobe resection by the first hepatic portal （first porta hepatis group）. The operative time, intraoperative bleeding volume, postoperative hos- pital stay, and postoperative complications of two kinds of operation were compared. Results The operative time and intraoperative bleeding volume of left longitudinal groove group were shorter or less than those of the first porta hepatis group （142 ± 123 ） rain vs. （208 ± 58） min, P〈 0. 05; （320. 5 ± 38.3 ） mL vs. （450. 9± 39. 1） mL, P〈 0. 05）. There were no statistically significant difference between the 2 groups in complication and hospitalization after operation （P〉0. 05）. Conclusion The left hepatic lobe resection by the left longitudinal groove is more safe and fast.