摘要
目的探讨肝蒂优先路径腹腔镜解剖性肝Ⅷ段切除术的可行性及安全性。方法回顾性分析2021年1月至2023年5月在滨州医学院烟台附属医院行肝蒂优先路径腹腔镜解剖性肝Ⅷ段切除的13例肝细胞癌患者的临床资料,其中男性10例,女性3例,年龄(65±8)岁,年龄范围为52~77岁。术中首先解剖第一肝门,处理Ⅷ段肝蒂,获得肝Ⅷ段缺血范围,根据缺血边界离断肝实质。记录患者的手术方式、手术时间、术中出血量、术后住院时间以及术后并发症。结果13例患者均顺利完成肝蒂优先腹腔镜解剖性肝Ⅷ段切除术,无中转开腹。5例患者Ⅷ段肝蒂从肝门附近的右前Glisson蒂分叉,其余患者Ⅷ段肝蒂位置较深,需离断肝门部分肝组织显露。手术时间为(295.3±47.1)min,术中出血量为100.0(60.0,200.0)ml,无术中输血,术后住院时间(7.1±1.2)d。13例患者中1例发生术后胆漏,引流7 d后自愈。结论肝蒂优先路径腹腔镜解剖性Ⅷ段切除安全可行,尤其适用于Ⅷ段肝蒂近肝门处起源于右前肝蒂的患者。
Objective To assess the safety and feasibility of laparoscopic anatomical hepatectomy for segmentⅧusing hepatic pedicle-first approach.Methods Thirteen patients with hepatocellular carcinoma undergoing laparoscopic anatomical hepatic segmentⅧresection at the Yantai Affiliated Hospital of Binzhou Medical University from January 2021 to May 2023 were enrolled,including 10 males and 3 females,aged(65±8)years old.During the operation,the hilar region was dissected to occlude the segmentⅧpedicle,the liver ischemic demarcation was obtained,and the liver parenchyma was transected tracing ischemic boundary.The methods of operation,operative time,intraoperative blood loss,postoperative complications and hospital-stay were retrospectively analyzed.Results Laparoscopic anatomical hepatic segmentⅧresection was successfully performed in 13 patients without conversion to laparotomy.Among them,the segmentⅧpedicle in five patients bifurcated from the right anterior Glisson pedicle near hilar region,while in other cases,segmentⅧpedicle originated in a deeper position,requiring partial transection of liver parenchyma.The operative time,intraoperative blood loss and postoperative hospital stay was(295.3±47.1)min,100.0(60.0,200.0)ml,and(7.1±1.2)d respectively.There was no intraoperative blood transfusion.One patient had postoperative biliary leakage,which was managed by drainage for 7 days,and other patients recovered uneventfully.Conclusion It is safe and feasible to perform laparoscopic anatomical segmentⅧresection using hepatic pedicle-first approach,which could be suitable for cases with segmentⅧpedicle originated from right anterior liver pedicle near hilar region.
作者
魏勇
牛洪凯
马维杰
成雨
Wei Yong;Niu Hongkai;Ma Weijie;Cheng Yu(Department of Hepatobiliary,Pancreatic and Spleen Surgery,Yantai Affiliated Hospital of Binzhou Medical University,Yantai 264100,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2024年第4期254-258,共5页
Chinese Journal of Hepatobiliary Surgery
关键词
癌
肝细胞
解剖性肝切除
肝Ⅷ段
腹腔镜
Carcinoma,hepatocellular
Anatomical hepatectomy
Liver segmentⅧ
Laparoscope
