腹腔镜左肝叶切除27例体会

Laparoscopic left hepatectomy:report of 27 cases

目的探讨腹腔镜左肝叶切除术的安全性,总结该术式的治疗经验。方法2006年2月至2007年9月对肝内胆管结石21例,肝血管瘤6例行腹腔镜左肝叶切除术。手术方式包括左半肝切除7例,左肝外叶切除20例。在腹腔镜下利用彭氏多功能解剖器(POMD)钝性解剖显露左门静脉、左肝动脉,完成区域性血流阻断。结果27例腹腔镜肝切除均获得成功。手术时间平均(182±22)min,平均出血量(224±87)ml,手术前后肝功能无显著变化。2例胆漏,1例肝内胆管小结石残留。平均住院时间(7±0.9)d。结论腹腔镜左肝叶切除术不但具微创的优点,而且安全可行。

Objective To evaluate the safety and feasibility of laparoscopic hepatic left lobectomy, and to summarize our experience. Methods The clinical data of 27 patients from February 2006 to September 2007 were analyzed ,including 21 cases of cholethiasis and 6 cases of hepatic hemangioma. Operative procedures included anatomical left hepatectomy in 7 cases,left lateral segmentectomies in 20 cases. Under laparoscopy ,the Peng multifunctional dissecter （PMOD） were utilized. The left branch of portal vein and hepatic artery were exposed by blunt dissection and selective portal occlusion was performed. Results Laparoscopic left hepatectomy was accomplished in all the 27 patients, without conversions to open surgery. The mean operating time was （182±22 ）min, and the mean intraoperative blood loss was （224±87 ）ml. No hepatic functinal change was found before and after the surgery. The post - operative recovery was smooth and good except that 2 patients had a complication of bile leakage, and one another patient had a small calculus residue in the intraheptatic duct. The mean hospital stay was （ 7 ±0.9 ） days. Conclusion Laparoscopic hepatic left lobectomy is safe,feasible and of minimal invasion.