腹腔镜肝切除治疗肝脏肿瘤15例临床分析

Laparoscopic liver resection for liver neoplasms in 15 cases

目的探讨完全腹腔镜肝切除治疗肝脏肿瘤的安全性及有效性。方法不阻断肝脏血流的情况下，联合采用超声刀、Ligasure及血管夹进行完全腹腔镜下肝切除15例，其中肝海绵状血管瘤9例，直径5．0～15．0cm（平均直径7．9cm），肝囊肿纤维化3例，其中2例为引流术后复发，均位于左外叶，左外叶明显缩小。原发性肝癌3例，直径1．0—5．0cm，肝功能均为Child A级。结果15例患者腹腔镜肝切除均获成功，其中左外叶切除6例，其余患者为肝不规则切除，无中转手术。平均手术时间110min，术中出血量30～500ml，平均251ml。术后平均住院时间6．5d，无术后死亡，术后除1例患者肝癌创面渗血，保守治愈外，其余无并发症，全部治愈。结论对位于Ⅱ、Ⅲ、Ⅳa、Ⅴ、Ⅵ段肝脏肿瘤患者，采用完全腹腔镜肝切除是一种安全有效的微创治疗方法。

Objective To evaluate the safety and feasibility of total laparoscopic hepatectomy for liver neoplasms. Methods Laparoscopic hepatectomy in 15 patients with liver neoplasms were completed by combined application of ultrasound scalpel, Ligasure and vascular clip without blockage of liver blood flow, including 9 cases of hepatic cavernous hemangioma, whose diameters were from 5.0 cm to 15. 0 cm, 3 cases of hepatic cyst with fibrosis, located in left lateral hepatic lobe, 3 cases of primary hepatic carcinoma, whose diameters were from 1.0 cm to 5.0 cm and the hepatic functions were all Child A. Results Laparoscopic hepatectomy was completed successfully in all 15 cases with no conversion to open laparotomy, including 6 cases of left lateral hepatectomy, 9 cases of irregular hepatectomy. The mean operative time was 110 min, blood loss during operation was from 30 ml to 500 ml, the average was 251 ml, The mean postoperative hospital stay was 6. 5 d. The mortality rate was 0%. No severe complications occurred except 1 case of small amount bleeding which stopped itself. Conclusion Total laparoscopic hepatectomy is a feasible, safe and minimal invasive approach for patients with liver neoplasms within segment Ⅱ ,Ⅲ ,Ⅳa,Ⅴ and Ⅵ.