腹腔镜肝切除术治疗肝血管瘤22例临床分析

Laparoscopic liver resection for hepatic hemangioma： a clinic analysis of 22 cases

目的探讨腹腔镜肝切除术治疗肝血管瘤的技术要点和疗效。方法回顾分析第三军医大学西南医院2007年3月1日至2008年2月29日22例肝血管瘤病人行腹腔镜肝切除术的临床资料。结果22例中2例中转开腹，20例完成全腹腔镜肝切除术。规则性肝叶（段）切除14例，其中左半肝切除5例，左外叶切除5例（其中1例联合右肝血管瘤射频消融术），Ⅵ段切除4例；不规则肝切除8例。10例在区域性半肝血流阻断条件下手术，7例行间歇性第一肝门血流阻断，5例未行人肝血流阻断。平均手术时间209min，平均术中出血量360ml。全组无手术死亡及并发症发生。术后恢复顺利，平均术后住院时间6d。随访2～14个月，无症状再发及肿瘤复发。结论腹腔镜肝切除术治疗肝血管瘤具有手术安全、并发症少和术后恢复快等优点，其技术要点是选择恰当适应证和手术入路，有效控制人肝血流和妥善处理肝断面，肝实质离断沿瘤体周围0．5～1Cm正常肝实质内进行或直接行荷瘤肝叶（段）规则性切除。

Objective To investigate technical features and efficacy of laparoscopic liver reset tion for hepatic hemangioma. Methods The clinic data of 22 patients with hepatic hemangioma receiving laparoscopic liver resection in our hospital from March 2007 to February 2008 were retrospectively analyzed. Results Twenty patients received successful total laparoscopic liver resection and 2 conversion to laparotomy. Anatomical liver resection was performed in 14 patients including 5 with left hemihepatectomy, 5 with left lateral segmenteetomy （1 combined with radiofrequency ablation for the tumor in the right liver lobe） and 4 with segment Ⅵ resection. Eight patients underwent nonanatomical hepatectomy. The liver parenchyma of 10 patients were transected under regional hemi-hepatic blood occlusion, 7 under intermittent Pringle＇s manoeuvre, and 5 without hepatic blood inflow block age. The mean operative duration was 209 rain （92-375 min） and mean blood loss 360ml （50 -1300 ml）. No operative death and postoperative complications occurred, and the patients recovered well. The mean postoperative hospital stay was 6 d （4 -10 d）. All the patients were followed up for 2-14 months and no recurrence was found. Conclusion The advantages of laparoscopic liver resection for hepatic hemangioma are safe operation, less complications, and quick postoperative recovery. The key points are right choice of surgical approach, effective control of hepatic blood inflow, proper man- agement of cutting surface of liver, and liver parenchyma amputation being performed 0. 5- 1 cm to tumor margin in the normal parenchyma or anatomical liver resection.