摘要
目的探讨腹腔镜肝脏手术(LH)中转开腹的原因,以期提高腹腔镜肝脏手术的安全性。方法本院2015年5月-2018年12月开展的40例腹腔镜肝脏手术中,5例中转。对5例患者的临床资料和手术情况进行回顾性分析,分析中转原因。结果中转患者中,男4例,女1例,年龄55~66岁;3例为肝细胞肝癌,1例为胆管细胞癌,1例为肝血管瘤。肝功能Child-Pugh分级全部为A级。病灶直径为2~6 cm,平均(3.8±1.4) cm。中转原因:4例为难以控制的出血,其中肝中静脉损伤3例,病灶与肝中静脉侧壁粘连,难以分离,中转后行侧壁修补止血;血管瘤血管损伤出血1例,中转后行血管结扎止血;1例为病灶侵犯门静脉根部,中转后经过仔细游离,将病灶与血管分开,完整切除肿瘤。5例患者术后并发症情况:肝衰竭1例,胆漏1例,均保守治疗而愈。所有中转患者均顺利康复出院,无围手术期死亡。结论术中顽固性出血和病变侵犯肝静脉系统是腹腔镜肝脏手术中转为剖腹手术的主要原因。
Objective To investigate the reasons for conversion to laparotomy laparoscopic liver surgery( LH),in order to improve the safety of laparoscopic liver surgery.Methods From May 2015 to December 2018,40 cases of laparoscopic liver surgery were performed at the Jijishan Hospital affiliated to Wannan Medical College,of which 5 cases were transferred. The clinical data and surgical conditions of 5 patients were retrospectively analyzed to analyze the causes of the transfer. Results Among the transfer patients,4 were male and 1 female,they were aged 55 to 66 years old.3 were hepatocellular carcinoma,1 was cholangiocarcinoma,and 1 was hepatic hemangioma.Liver function Child-Pugh grades are all grade A.The lesions were 2 to 6 cm in diameter and averaged( 3. 8 ± 1. 4) cm. Causes of transfer: 4 cases were uncontrollable hemorrhage,including 3 cases of hepatic venous injury.The lesion was adhered to the side wall of the hepatic vein,it was difficult to separate.After the transfer,the side wall was repaired to stop bleeding.The vascular injury of hemangioma was treated in 1 case.Blood vessel ligation and hemostasis;1 case was the lesion invading the root of the portal vein. After careful transfer,the lesion was separated from the blood vessel and the tumor was completely removed. Postoperative complications in 5 patients: 1 case of liver failure and 1 case of bile leakage,and they were treated with conservative treatment.All patients with transit were successfully discharged and discharged without perioperative period.Conclusions Intraoperative refractory hemorrhage and pathological invasion of the hepatic venous system are the main reasons for conversion to laparotomy during laparoscopic liver surgery.
作者
王传喜
胡明华
王小明
钱道海
WANG Chuan-xi(Department of hepatobiliary surgery,Yanjishan hospital,Wannan Medical College,Wuhu,Anhui,241001,China)
出处
《齐齐哈尔医学院学报》
2019年第11期1384-1386,共3页
Journal of Qiqihar Medical University
关键词
腹腔镜
肝脏手术
出血
中转
开腹手术
Laparoscopy
Liver surgery
Bleeding
Transit
Open surgery
