完全腹腔镜下肝左外叶部分切除术：附6例报告

Total laparoscopic left lateral sectionectomy： a report of 6 cases

背景虽然腹腔镜下肝脏切除的技术进展缓慢，但是仍有证据表明在选择性病例中运用腹腔镜技术进行一些较小型的肝切除，特别是肝左外叶切除术是安全的。目的探讨运用腹腔镜技术进行肝左外叶切除的操作技术和经验。方法回顾性分析我院在2004—2005年间接受完全腹腔镜下肝左外叶切除的6例病人的临床资料，包括围手术期数据、病理结果、随访数据等。结果6例病人均行完全腹腔镜下肝左外叶切除术，无需中转开腹，无术中死亡和术后并发症；全组病例平均手术时间为195min，术中平均出血量170ml；其中4例病理诊断为肝细胞性肝癌，1例为局灶性结节样增生，1例为肝血管瘤；4例肝癌病人的手术切缘不少于1cm;平均住院时间为3d（2～6d），中位随访时间为12个月；4例肝癌病人至今均未见复发。结论采用完全腹腔镜下肝左外叶切除，技术安全可行，并能大大减轻病人的手术创伤。

Objective To describe the technique of resecting the left lateral section of liver using total laparoscopic approach and evaluate its results. Methods The perioperative data, pathology and follow-up results were retrospectively analyzed for 6 consecutive patients undergoing total laparoscopic left lateral sectionectomy in our unit from 2004 to 2005. Results All 6 operations were completed laparoscopically. There was no operative morbidity or mortality. Mean operation time was 195 min. Mean blood loss was 170 ml. Histological examination revealed that 4 patients suffered from hepatocellular carcinoma （HCC）, 1 from focal nodular hyperplasia （FNH） and 1 from haemangioma. The resection margins were more than 1 cm in all malignant cases. The median hospital stay was 3 days and the median follow-up time was 12 momhs. There was no evidence of recurrence in the malignant cases till the end of the follow-up. Conclusion Total laparoscopic technique in resecting left lateral section of liver is safe and feasible. It conveys the benefits of minimal invasive surgery to patients, even in those with malignant disease and cirrhosis.