摘要
目的探讨肝蒂优先路径腹腔镜解剖性中央肝段切除术的可行性及安全性。方法回顾分析2020年9月至2023年1月解放军总医院第一医学中心肝胆胰外科医学部收治的19例行肝蒂优先路径腹腔镜解剖性中央肝段切除的肝细胞癌患者的临床资料,其中男性14例,女性5例,年龄(59.9±3.2)岁。腹腔镜解剖性肝切除手术首先处理目标肝蒂,获得相应的肝段缺血范围,根据缺血边界离断肝实质。分析手术方式、手术时间、术中出血量、术后住院时间以及术后并发症等。结果19例患者均顺利完成肝蒂优先路径腹腔镜解剖性中央肝段切除术,无中转开腹,包括Ⅳ段切除5例、Ⅳ+Ⅷ段切除2例、Ⅳ+Ⅷ腹侧段切除3例、Ⅳa+Ⅴ+Ⅷ段切除3例、Ⅴ+Ⅷ段切除6例。19例患者手术时间(253.1±86.1)min,术中出血量[M(Q_(1),Q_(3))]100.0(100.0,250.0)ml,无术中输血,术后住院时间(5.1±1.2)d。术后患者均恢复良好,无并发症发生。结论肝蒂优先路径腹腔镜解剖性中央肝段切除可在术中标定出肝段边界,该技术方法安全,可临床进一步推广。
Objective To assess the safety and feasibility of hepatic pedicle-first approach laparoscopic anatomical hepatectomy for central segments.Methods The clinical data of 19 patients with hepatocellular carcinoma who underwent hepatic pedicle-first approach laparoscopic anatomical hepatectomy for the central segments in the Faculty of Hepato-Pancreato-Biliary Surgery,Chinese PLA General Hospital from September 2020 to January 2023 were retrospectively analyzed.In this procedure,hepatic pedicles of the central segments were divided first to delineate the ischemic demarcation and guide the liver parenchymal transection.The methods of operation,operation time,intraoperative blood loss,postoperative complications and hospital-stay were analyzed.Results Hepatic pedicle-first approach laparoscopic anatomical hepatectomy for the central segments was successfully performed in all patients,including 5 cases of segmentⅣ,2 cases of segmentⅣ+Ⅷ,3 cases of segmentⅣ+ventral segmentⅧ,3 cases of segmentⅣa+Ⅴ+Ⅷ and 6 cases of segmentⅤ+Ⅷ.The mean operation time,intraoperative blood loss and postoperative hospital stay was(253.1±86.1)min,[M(Q_(1),Q_(3))]100.0(100.0,250.0)ml,and(5.1±1.2)d respectively.There was no intraoperative blood transfusion and postoperative complications.Conclusion Hepatic pedicle-first approach can help delineate the segemental demarcation in laparoscopic anatomical hepatectomy for the central segments,which is technically feasible and worth more practice.
作者
陈继业
杨滔
苏明
韩骏
蔡守旺
Chen Jiye;Yang Tao;Su Ming;Han Jun;Cai Shouwang(Faculty of Hepato-Pancreato-Biliary Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2023年第5期324-327,共4页
Chinese Journal of Hepatobiliary Surgery
关键词
癌
肝细胞
腹腔镜检查
肝段
解剖性肝切除
Carcinoma,hepatocellular
Laparoscopy
Hepatic segment
Anatomical hepatectomy
