摘要
目的探讨腹腔镜肝切除术的应用指征、技术要点和疗效。方法回顾分析笔者所在医院2007年1月至2012年12月期间完成各类腹腔镜肝切除术61例患者的临床资料和随访结果。结果 61例中原发性肝癌16例,肝腺癌1例,转移性肝癌2例,肝血管瘤31例,其他肝脏良性占性病变(肝包虫病、肝细胞腺瘤、局灶性结节增生、肝囊肿及黏液性囊腺瘤)11例,肿瘤直径平均为5.6 cm(2～15 cm)。手术方式包括腹腔镜下左肝外叶切除术42例,右肝后叶切除术2例,Ⅵ段肝切除术3例,Ⅶ/Ⅷ段、Ⅳa及尾状叶肝切除术各1例,病变局部不规则性切除11例。手术时间为(124±65)min(50～200 min),术中出血量为(251±145)mL(50～1 000 mL),无一例手术死亡,术后住院时间为(7.3±3.6)d(4～11 d)。并发症总发生率为16.4%(10/61)。19例肝脏恶性肿瘤患者中15例随访1～48个月,平均26个月,失访4例;其中1例于术后12个月时因多器官功能衰竭死亡,其余均存活。结论经验丰富的腹腔镜肝胆胰外科医生选取合适的病例,采用恰当的血流阻断及断肝方法,注意术中的无瘤原则,可以安全有效地开展肝脏良、恶性肿瘤的腹腔镜肝切除术。
Objective To approach the indications, techniques features, and efficacy of laparoscopic hepatectomy for liver tumor. Methods The clinical data and follow-up results of 61 patients who received laparoscopic hepatectomy at our institute from January, 2007 to December, 2012 were retrospectively analyzed. Results Of the 61 patients, 16 cases were with primary liver cancer, 1 case with liver adenocarcinoma, 2cases with metastatic liver cancer, 31 cases with hepatic hemangioma, and 11 cases with other benign liver diseases （including hepatocellular adenoma, focal nodular hyperplasia, hepatic cysts, and mucinous cystadenoma）. The average tumor diameter was 5.6 cm （2-15 cm）. The surgical approaches includes laparoscopic hepatic left lateral lobectomy （42 cases）, right posterior lobectomy （2 cases）, hepatectomy of segment VI （3 cases）, hepatectomy of segments V~/V~, IVa, and caudate lobe （one respectively）. Non- anntomic and wedge resection were performed on 11 patients. The mean operating time, blood loss, postoperative hospital stay, and postoperative complication rate were （124___ 65） min （50-200 min）, （251 ＋__ 145） mL （50-1 000 mL）, （7. 3__＋3.6） d （4-11 d）, and 16. 3% （10/61）, respectively. In 19 cases with malignant liver lesions, 15 cases were followed up mean for 26 months （1-48 months）. One of them died in 1 year after operation for multiple organ dysfunction, others were survival. Conclusions Experienced laparoscopic surgery doctors selected appropriate cases, used proper blood inflow oclussion and liver resction methods, and cared for tumor-free principle, the laparoscopic hepatectomy for malignant and benign tumors of liver could be safe and effective to carry out.
出处
《中国普外基础与临床杂志》
CAS
2013年第4期367-370,共4页
Chinese Journal of Bases and Clinics In General Surgery
关键词
肝脏肿瘤
肝切除术
腹腔镜
Liver neoplasm
Hepatectomy
Laparoscope
