腹腔镜肝肿瘤切除术21例临床分析

2007年12月至2012年10月我院行腹腔镜肝肿瘤切除术21例,其中11例为边缘型恶性肝肿瘤,直径1.0 ～ 9.0 cm（6例直径≤2.0 cm）,10例为边缘型良性肝占位病变；肿瘤部位CouinaudⅢ段13例、Ⅳ段内6例、Ⅴ段1例、Ⅵ段内1例；11例为肝细胞癌,7例为肝血管瘤,肝腺瘤1例,肝淋巴瘤1例,肝灶性坏死l例.手术切除均成功,无中转开腹,无胆漏、空气栓塞、死亡等手术并发症,平均手术时间（120±30）min,平均出血量（165±79）ml,术后1～2d开始进食和下床,术后1周外周血WBC计数、白蛋白、胆红素水平恢复正常,平均住院时间（16±10）d；1年生存率100％.合理选择手术适应证,腹腔镜肝肿瘤切除术安全、有效,尤其适用于周围型微小肝肿瘤.

Clinical analyses of laparoscopic hepatectomy for liver neoplasms : a report of 21 cases

The clinical data were retrospectively analyzed for 21 cases of liver neoplasms undergoing laparoscopic hepatectomy from December 2007 to October 2012.Among 11 cases of borderline hepatocellular carcinoma （HCC） （1.0-9.0 cm）,6 of them were of micro hepatocellular carcinoma （MHCC） with a diameter ≤2 cm.There were 10 cases of borderline hepatic benign tumor,including liver hemangioma （n =7）,hepatic adenoma （n =1）,liver lymphoma （n =1） and liver focal necrosis （n =1）.According to Couinaud＇s liver segmentation method,neoplasm was located on segment Ⅲ （n =13）,segment Ⅳ （n =6）,segment Ⅴ （n =1） and segment Ⅵ （n =1）.Laparoscopic hepatectomy was successful in all patients.There was neither conversion into open approach nor postoperative complications of bile leakage,air embolism or perioperative mortality,etc.The mean operative duration was （120 ± 30） minutes,average hemorrhagic volume （165-±79） ml and normal diet ＆ ambulation at Day 1-2 post-operation.The average postoperative hospitalization stay was （16 ± 10）days and l-year survival rate 100%.The parameters of leucocyte,liver enzymes,albumin and bilirubin returned to normal at Week 1 post-operation.Once a reasonable surgical indication is selected,laparoscopic resection is both safe and effective for peripheral micro hepatocellular carcinoma.