腹腔镜超声在腹腔镜肝部分切除术中的应用

Application of laparoscopic ultrasonography in laparoscopic hepatectomy

目的探讨腹腔镜超声在腹腔镜肝部分切除术中的作用。方法在16例腹腔镜肝部分切除术中,应用腹腔镜超声进行检查。结果术中超声纠正了2/17例(11.8%)术前诊断,因此改变术式。1例(5.9%)发现伴有胆总管结石,予切开胆总管取石。1例(5.9%)发现Ⅳ段有1cm×1cm×1cm大小子灶,予一并切除。17例均有超声辅助确定肝切除线。术后病理证实切缘无肿瘤残余。17例患者均在腹腔镜下完成手术。术中未出现不能控制并发症。结论应用腹腔镜超声探查肝脏,补充和纠正术前影像学检查的错漏;进行准确的病灶边界定位;找到肝段的胆管、血管蒂控制出血,可提高诊断准确率及腹腔镜肝切除的安全性,对腹腔镜肝部分切除术具有实用价值。

[Objective] To explore the clinical value of laparoscopic ultrasonography in laparoscopic partial hep- atectomy. [Methods] 16 cases of laparoscopic partial hepatectomy which were performed using laparoscopic ultrasonography during the operations. [Results] Preoperative diagnoses and operation procedures of 2 of 17 patients （11.8%） were retrieved by LUS. One （5.9%） was noticed with commen duct stones and underwent exploration and stone exraction. One was noticed with a 1 cm×1 cm×1 cm daughter nodule in segment IV, which was removed. Post operative histologic test showed clear margin. 17 patients were operated under laparoscopy. There was no conversion to laparotomy, and no intraoperative uncontrollable complications. [Conclusions] The significance of LUS in laparoscopic hepatectomy include： correcting preoperative imaging results; labeling accurately the hepatectomy line; Minimizing bleeding during operation by controlling segmental pedicle. So it can improve the safety and accuracy of laparoscopic hepatectomy and should be applied routinely in laparoscopic hepatectomy.