腹腔镜肝切除术11例临床报告

Laparoscopic hepatectomy:with a report of 11 cases

目的:探讨腹腔镜肝切除术的适应证和可行性。方法:回顾分析10例病灶位于肝脏边缘及左肝外叶(Ⅱ～Ⅵ段)及1例位于Ⅷ段的肝占位患者的临床资料。其中原发性肝细胞癌8例,肝海绵状血管瘤2例,胆管细胞癌1例,肝功能Child-Pugh评分A级9例,B级2例;AFP(+)7例;位于左肝外叶实质中的肿瘤,行规则性左肝外叶切除;位于肝脏边缘或右肝表面的肿瘤,行肝脏局部切除。结果:11例均成功完成腹腔镜肝切除术,无中转开腹。其中局部切除术7例,左肝外叶切除术4例,腹腔镜脾切除+胆囊切除术2例。平均手术时间105min,术中平均出血220ml,切除病灶最大直径10cm。全部肿瘤均完整切除,肿瘤包膜完整,无破裂。术后未发生胆漏和出血等并发症,恢复良好,术后平均住院8.5d。结论:位于肝脏边缘、右肝表面或左半肝(Ⅱ～Ⅵ段)的肝脏占位,行腹腔镜肝切除术是安全可行的。

Objective：To evaluate the indication and feasibility of laparoscopic hepatectomy. Methods：Eleven patients were selected in this study, 10 of them with lesions located in edge of liver and left lateral segments（ II-VI segment） ,one of them with tumor in VIII segment. There were 8 cases of primary hepatocellular carcinoma,2 cases of liver cavernous hemangioma, and 1 case of cholangio- cellular carcinoma. The liver function of 9 cases were in Child-Pugh A and 2 cases in Child-Pugh B ;7 cases were AFP（＋）. For those tumors located in the left lateral segments, regular left lateral lobe of liver resection were performed ; and in the edge of liver and surface of fight liver,local resection of liver were selected. Results：All 11 patients were applied laparoscopic liver resection successfully, without conversion to open surgery. 7 of all were performed partial resection,4 cases underwent laparoscopic hepatic left lateral lobectomy. 2 cases combined with laparoscopie splenectomy and laparoscopic cholecystectomy. The average operation time was 105 minutes, and the intraoperative average hemorrhage was 220ml. The maximum diameter of tumor was 10cm. All of the tumors were removed en bloc ,with intact envelope. There were no postoperative complications such as bile leakage or hemorrhage. All patients recovered well. The average postoperative stay was 8.5 days. Conclusions：Laparoscopic hepatectomy is safe and feasible for tumor located in the edge of liver, surface of fight liver and left liver（II -VI segment）.