腹腔镜肝切除术的临床应用

Laparoscopic hepatectomy for benign and malignant liver diseases.

目的探讨腹腔镜肝脏切除术的可行性、适应证及方法。方法行腹腔镜下肝脏切除术42例，其中行肝左外叶切除术6例，肝癌局部切除术22例，肝局限性结节性增生局部切除术11例，肝血管瘤切除术3例。结果41例在完全腹腔镜下完成手术，1例为手助式腹腔镜肝切除术，全组病例均经病理检查证实。平均手术时间168min，平均出血量120mL，术后48h内胃肠功能恢复，术后平均住院8．2d，痊愈出院，无严重并发症发生。肝脏恶性肿瘤患者术后随访6个月～3年，无局部复发或腹壁戳孔种植转移。结论腹腔镜下肝切除术是一种安全、有效、微创的手术，但应严格掌握适应证。

Objective To investigate the feasibility, indications and methods for laparoscopic bepatectomy. Methods From Jun. 1998 to Jun. 2006,42 patients with benign or malignant liver diseases underwent laparoscopic hepatectomies which included left lateral hepatectomy （ n = 6 ）, partial hepatectomy for malignant liver tumor （ n = 22） , enucleation of focal nodular hyperplasia （ n = 11 ） and enucleation of bemangioma （ n = 3 ） . Results Forty one cases received the laparoscopic procedure and another received hand-assisted procedure. Mean operation time was 168 minutes,mean blood loss was 120 ral. No case converted to open procedure, and no serious complications happened. All the patients recovered successfully. The mean hospital stay was 8.2 days. The patients with malignant tumor were followed up for 6 to 36 months and there was no local recurrence. Conclusion Laparoscopic hepatectomy is a safe , effective and minimally invasive procedure for selected patients and we must follow the indications strictly.