摘要
目的探讨左侧卧位腹腔镜肝右叶各肝段部分切除的可行性及疗效。方法回顾性分析右江民族医学院附属医院百东院区2022年5月至2023年4月期间39例行左侧卧位腹腔镜肝右叶部分切除术的病例资料。结果39例中有腹部手术史者13例;肿瘤1个34例,肿瘤2个3例,肿瘤3个2例,肿瘤最大径37.0(24.0,58.0)mm。其中行非解剖性肝切除20例,解剖性肝切除19例;单一肝段切除术28例,两部位肝部分切除术10例,三部位肝部分切除术1例;联合腹腔镜胆囊切除24例;无血流阻断9例,行Pringle法血流阻断30例。平均手术时间(143.5±56.8)min;中位术中出血量100.0(50.0,300.0)mL,4例术中输血(合计29.50 U),无中转开腹。35例放置引流管,引流管留置时间(6.3±3.7)d;术后平均住院时间(10.1±4.0)d,住院总费用(41121.8±18978.3)元。术后23例患者出现少量胸腔积液;1例患者并发急性呼吸窘迫综合征(ARDS)及肝功能不全,经ICU复苏治愈;1例出现少量气胸;无感染、出血、胆漏等并发症发生;无非计划性再次手术发生。所有患者均通过门诊或电话的方式获得随访,所有病例近期无复发。结论左侧卧位行腹腔镜肝右叶部分切除术操作简单,暴露好,手术时间相对较短,出血少。
Objective To investigate the feasibility and efficacy of laparoscopic partial resection of various liver segments in the right lobe of the liver in the left lateral position.Methods The data of 39 patients,who underwent laparoscopic partial resection of the right lobe of the liver in the left lateral position from May 2022 to Apr.2023 in Baidong Branch of Affiliated Hospital of Youjiang Medical University of Nationalities,were retrospectively analyzed.Results Among the 39 cases,13 had a history of abdominal surgery;34 cases with 1 tumor,3 cases with 2 tumors,and 2 cases with 3 tumors,with a median maximum tumor diameter of 37.0(24.0,58.0)mm.Out of the 39 patients,non-anatomical liver resection was performed in 20 cases and anatomical liver resection in 19 cases;Single liver segmentectomy was performed in 28 cases,two-sites partial hepatectomy in 10 cases and three-sites partial hepatectomy in 1 case.Additionally,24 cases received combined laparoscopic cholecystectomy.Pringle’s hepatic vascular occlusion was performed in 30 cases,the other 9 cases did not received Pringle’s hepatic vascular occlusion.The average operation time was(143.5±56.8)min,the with a median intraoperative bleeding volume of 100.0(50.0,300.0)mL,and 4 cases required intraoperative blood transfusion(total 29.50 U);No case of conversion to open surgery.Drainage were applied in 35 cases,with a mean time of drainage tube indwelling of(6.3±3.7)d.The average postoperative hospitalization time was(10.1±4.0)d,and the total hospitalization cost was(41121.8±18978.3)yuan.After surgery,23 patients developed a small amount of pleural effusion;1 patient develeped acute respiratory distress syndrome(ARDS)and liver insufficiency,which was resuscitated through ICU,cured;1 patient had a small amount of pneumothorax;No case of infection,bleeding,bile leakage or other complications.No unplanned reoperation occurred.All patients were followed-up by outpatient service or telephone,and no recent recurrence was found in all cases.Conclusion Laparoscopic parti
作者
袁汉坤
游声林
梁文祥
周嘉杰
陆礼柏
罗宗将
马嘉盛
李鸿飞
汪建初
YUAN Hankun;YOU Shenglin;LIANG Wenxiang;ZHOU Jiajie;LU Libai;LUO Zongjiang;MA Jiasheng;LI Hongfei;WANG Jianchu(Department of Hepatobiliary and Pancreatic Surgery,Baidong Branch,Affiliated Hospital of Youjiang Medical University of Nationalities,Baise,Guangxi 533000,China;Department of Hepatobiliary Surgery,People’s Hospital of Hechi,Hechi,Guangxi 547000,China)
出处
《肝胆胰外科杂志》
CAS
2024年第5期282-286,293,共6页
Journal of Hepatopancreatobiliary Surgery
基金
国家自然科学基金项目(82060441)。
关键词
左侧卧位
腹腔镜手术
肝右叶
肝部分切除术
肝细胞瘤
肝血管瘤
肝转移瘤
left lateral position
laparoscopy
right lobe of liver
partial hepatectomy
hepatocelluar carcinoma
hepatic hemangioma
liver metastases
