腹腔镜肝切除术在治疗肝血管瘤中的价值

目的探讨腹腔镜肝血管瘤手术的可行性和疗效。方法回顾性分析2006年6月～2012年1月66例腹腔镜肝切除术治疗肝血管瘤的临床资料。断肝方式为超声刀+LigaSure联合分离法,结合腔镜下切割缝合器。结果行左半肝切除7例,左外叶切除28例(包括1例单孔左外叶切除),肝段切除8例,右半肝切除9例,局部切除14例。术后病理证实海绵状血管瘤55例,硬化性血管瘤4例,血管内皮细胞瘤3例,毛细血管瘤4例。手术时间43～380 min,平均165 min。术中出血量50～1100 ml,平均210 ml。术后腹腔引流量15～650 ml,平均180.4 ml。2例术后胆漏,经充分引流7天和20天治愈。术后住院时间3～13 d,平均5.8 d。结论在病例选择适当时,腹腔镜下肝血管瘤手术是一种安全、有效、微创的手术,可安全用于局部、肝段及半肝切除术。

Laparoscopic Hepatectomy for Hepatic Hemangioma

Objective To evaluate the feasibility and efficacy of laparoscopic hepatectomy （ LH ） for hepatic hemangioma. Methods The clinical data of 66 cases of hepatic hemangioma that received laparoscopic treatment from June 2006 to January 2012, including operation time, intraoperative blood loss and postoperative complications, were analyzed retrospectively. The parenchyma was transected by using laparoscopic ultrasonic scalpel ＋ LigaSure, accomplished with endoscopic linear stapler. Results The operations included left hemihepatectomy （ n = 7 ）, left lateral lobectomy （ n = 28, including one case of single-hole left lateral lobectomy）, segmentectomy （ n = 8 ）, right hemihepatectomy （ n = 9 ）, and local resection （ n = 14 ）. Postoperative pathological examination showed cavernous hemangioma in 55 patients, sclerosing hemangioma in 4, hemangioendothelioma in 3, and capillary hemangioma in 4. The mean operation time was 165 min （43 - 380 rain）. The mean intraoperative blood loss was 210 （50 - 1100 ml）. The volume of postoperative drainage was 180.4 ml in average （ 15 - 650 ml）. And the mean postoperative hospital day was 5.8 days （3- 13 days）. Two patients developed postoperative biliary leakage, and were then cured by drainage in 7 or 20 days. Conclusion LH is a safe, feasible and effective procedure for the treatment of hepatic hemangioma for selective patients.