手辅助腹腔镜肝癌切除术的临床应用

THE CLINICAL APPLICATION OF HAND-ASSISTED LAPAROSCOPIC HEPATECTOMY FOR LIVER CANCER

目的探讨手助腹腔镜下肝癌切除的适应症及临床效果.方法经Lapdisc辅助腹腔镜下完成11例肝癌切除,其中男7例,女4例,年龄36～62岁,平均年龄58.8±8.4岁,原发性肝癌8例,肝转移癌3例.结果所有病人手助腹腔镜下均顺利切除病灶,无中转开腹手术,其中右肝部分切除8例,左肝部分切除1例,左肝外叶切除2例.手术时间65～270 min,平均180.5±55.6min,出血量100～1100 ml,平均320.5±46.8 ml,切除肿瘤体积2×3×2～10×8× 7 cm3.无胆漏、腹腔出血及感染等术后并发症,住院时间4～18 d,平均8.8±2.3 d.随访3～13 mon,8.5±3.4 mon,无远期并发症.结论手助腹腔镜下肝癌切除安全可行,可作为肝癌切除的新方法.

Objective To evaluate the indication and clinical results of hepatectomy for liver cancer with hand-assisted laparoscopic surgery （HALS）. Methods Eight patients with primary liver cancer and 3 patients with metastasis liver cancer （7 male, 4 female; mean age 58.8±8.4 years） underwent HALS hepatectomy for liver cancer with lapdisc system. Result The hand-assisted laparoscopic hepatectomy were successfully performed in all patients （incluing left lateral segmentectomy in 2 cases, right posterior hepatic bisegmentectomyin 1 case and partial hepatectomyin 8cases）. The volume of resected tumor was 2×3×2-10×8×7 cm^3. The mean operating time was 180.5±55.6 min（65 min-270min）. Mean blood loss was 320.5±46.8 ml（100 ml-1100 ml）and mean postoperative hospital stay was 8. 8±2. 3 d （4 d-18 d）. There was no severce postoperative complications, such as bile leakage, bleeding or infection of abdominal cavity. With a follow-up of 3-13mon, there was no significant long-term complication. Conclusion Hand-assisted laparoscopic hepatectomy for liver cancer is feasible and safe. It should be a promising technique.