摘要
目的探讨腹腔镜肝肿瘤切除术的临床疗效。方法回顾性分析2010年3月至2013年1月福建医科大学附属第一医院收治的258例行腹腔镜肝肿瘤切除术患者的临床资料，包括原发性肝癌196例、肝血管瘤45例、肝脏局灶结节性增生13例、肝转移癌2例、胆囊癌1例、肝脏错构瘤1例。所有患者采用电话和门诊随访，随访时间截至2013年3月。结果258例患者中行单个肝段肿瘤切除者142例、跨肝段肿瘤切除者98例、多发肿瘤切除者18例。51例患者行肝肿瘤合并胆囊切除。258例患者均成功在完全腹腔镜下切除肿瘤，无中转开腹。切除肿瘤直径（5±3）cm（1．0—11．5cm），手术时间为（113±56）min（50～310min）。122例患者术中行肝门阻断，总阻断时间为（15±7）min。患者术中出血量为（211±195）mL（10—650mL），术中均未输血。切除肿瘤包膜完整，恶性肿瘤的边界距肿瘤切缘均〉1．5cm，术后病理检查证实切缘均为阴性。术后1周患者肝功能恢复至接近正常水平，无肝衰竭发生。术后住院时间为（7．2±1．3）d（5～10d）。1例患者术后出现胆汁漏，6例出现轻度腹腔积液，其余患者均未出现术后并发症。患者随访率为91．47％（236／258），随访时间为（16±10）个月。199例恶性肿瘤患者均获随访，其中180例无瘤生存；18例术后肿瘤复发；1例于术后6个月出现大网膜种植性转移，行手术切除。获得随访的37例良性肝肿瘤患者均健康生存。结论腹腔镜肝切除术治疗各种肝脏肿瘤安全有效。在腹腔镜下短时间分次行肝门阻断，可提高手术安全性，不会明显延长恢复时间。
Objective To investigate the clinical efficacy of laparoscopic hepatectomy. Methods The clinical data of 258 patients who received laparoscopic hepatectomy at the First Affiliated Hospital of Fujian Medical University from March 2010 to January 2013 were retrospectively analyzed. There were 196 patients with primary hepatic cancer, 45 with hepatic hemangioma, 13 with hepatic focal nodular hyperplasia, 2 with hepatic metastatic cancer, 1 with carcinoma of gallbladder and 1 with hepatic hamartoma. All patients were followed up via phone call or out-patient examination till March 2013. Results A total of 142 patients received single hepatic segmen- tectomy, 98 received multiple hepatic segmentectomy, 18 received multiple lesions resection. Fifty-one patients received hepatic tumorectomy ＋ eholecystectomy. All the operations were successfully done under laparoscope with- out conversion to the open surgery. The mean tumor diameter and the operation time were （5 -＋ 3） cm （ range, 1.0- 11.5 cm） and （ 113 ± 56） minutes （ range, 50- 310 minutes）, respectively. Intraoperative hepatic portal occlusion was performed on 122 patients, and the time for hepatic portal occlusion was （15 ± 7 ）minutes. The volume of intraoperative blood loss was （211 ＋ 195 ）mL （range, 10-650 mL）, and blood transfusion was not needed. The capsule of the tumor was complete. The distance between the resection margin and the malignant tumor was above 1.5 cm, and there was no residual tumor in the resection margin. The hepatic function was back to the normal level in 1 week after the operation, and no patient had hepatic failure. The duration of postoperative hospital stay was （7.2 ± 1.3 ）days （range, 5-10 days）. One patient was complicated with bile leakage, 6 with slight peritoneal effusion, and other patients had no postoperative complications. The rate of follow-up was 91.47% （236/258）, and the time of follow-up was （ 16 ± 10 ） months. A total of 199 patients with malignant hepatic tumors were fo
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2014年第3期198-201,共4页
Chinese Journal of Digestive Surgery
基金
福建省自然科学基金（2011J01162）
福建省属高校基金（JK2011021）
