完全腹腔镜下肝部分切除治疗体会

目的探讨腹腔镜肝部分切除术的适应证、可行性及手术操作技术。方法回顾分析2009年7月至2009年12月在我院行腹腔镜部分肝切除9例患者的临床资料。其中原发性肝细胞肝癌5例,直肠癌肝转移瘤1例,肝海绵状血管瘤1例,肝内胆管结石2例,肝功能Child-Pugh评分均在B级以上。位于左半肝实质中的肿瘤及左半肝肝内胆管结石,行规则性左半肝切除;位于肝脏边缘或右肝表面的肿瘤,行肝脏局部切除。结果 8例成功完成腹腔镜肝切除术,其中局部切除术1例,左肝外叶切除术5例,左半肝切除术2例。1例因术中出血较多(800ml)而中转开腹手术。平均手术时间(173±52)min,术中平均出血(402±91)ml,切除病灶最大直径8cm。全部患者肿瘤均完整切除,肿瘤包膜完整。术后未发生明显胆漏和出血等并发症,患者恢复良好,术后平均住院(8.3±3.2)d。结论位于肝脏边缘、右肝表面或左半肝的肝脏占位或肝内胆管结石,在充分掌握适应证及相应的手术操作技巧的基础上,行腹腔镜肝切除术是安全可行的。

The therapeutic experiences of laparoscopic partial hepatectomy

Objective To evaluate the indication、feasibility and techniques in laparoscopic liver resections.Methods Retrospectively analysis on 9 patients with both their lesions located at liver margin, or the surface of the right liver,or left liver or intrahepatic bile duct stones in our hospital from July 2009 to December 2009.Their liver function classification was child B or above,including 5 cases of primary liver cancer, 1 case of metastatic hepatotumor, 3 cases of liver hemangioma, 2 cases of intrahepatic bile duct stones.Results The laparoscopic hepatectomy was accomplished successfully in 8 patients,including 1case of local liver resection,7 cases of anatomical left liver resection.The operation time was 173±52 min,the blood loss was 402±91 ml.No bile leakage,bleeding or other complications happened.The postoperative hospital stay was 8.3±3.2 d.Conclusions Laparoscopic hepatectomy is safe and feasible for selected patients.Appropriate choices of surgical indication and careful surgical performance are essential to the success of surgery.