手助腹腔镜大肝肿瘤切除86例

目的探讨手助腹腔镜大肝肿瘤切除的可行性和安全性。方法对病变位于肝外周部位(Ⅱ～Ⅵ段)且直径5cm的86例大肝肿瘤患者,采用手助腹腔镜行规则或不规则性肝切除术。其中肝细胞癌56例,肝内胆管细胞癌3例,肝海绵状血管瘤23例,肝转移性鳞癌、肝局灶性结节增生、肝囊腺瘤和肝梭形细胞瘤各1例。结果 86例手助腹腔镜肝切除术均获得成功,肝左外叶切除41例,左半肝切除8例,不规则性肝切除37例,术中52例行肝门阻断,平均阻断时间为14.5min,平均手术时间为109min,平均出血量为112ml,瘤体直径平均为8.3cm,术后无严重并发症发生,平均住院日为7.9d。结论只要病例选择得当,手助腹腔镜大肝肿瘤切除术是安全可行的。

Hand-assisted laparoscopic hepatectomy for large hepatoma in 86 cases

Objective To study the feasibility and safety of hand-assisted laparoscopic hepatectomy for large hepatoma.Methods Eighty-six patients with large hepatoma underwent hand- assisted laparoscopic hepatectomy including 56 cases of hepatocellular carcinoma,3 cases of cholangcelluar carcinoma,23 cases of hepatic cavernous hemangioma,1 case of hepatic metastatic squamous carcinoma, 1 case of hepatic focal nodular hyperplasia,1 case of hepatic cystadenoma and 1 case of hepatic spindle cell tumour.Results The operation procedures were completed safely in all patients including 41 left lateral segmentectomies,8 left hemihepatectomies and 37 atypical hepatectomies.52 cases with hepatic hilum blocking in the procedure and the mean time was 14.5 minutes.Mean surgical time was 109 minutes. Mean blood loss was 112 ml.Mean gross tumor volume was 8.3cm.No serious postoperative complications occurred.The mean postoperative hospital stay was 7.9 days.Conclusions Hand-assisted laparoscopic Hepatectomy for large hepatoma is feasible and safe for selected patients.