完全腹腔镜下肝切除(附13例报道)

Complete Laparoscopic Hepatectomy(A Report of 13 Cases)

目的探讨完全腹腔镜下肝切除手术的微创方法及疗效。方法2005年6月~2009年5月行腹腔镜肝切除术13例,其中肝癌3例,肝脏皮样囊肿2例,鼻咽癌肝转移1例,肝血管瘤4例,肝脏增生结节并胆囊结石2例,肝腺瘤1例。应用自行设计的＂体外硬管肝门阻断法＂阻断入肝血流6例,未阻断入肝血流7例。结果13例成功地在完全腹腔镜下完成手术,未阻断组术中出血量平均（612.8±24.6）ml,手术时间平均（120.0±60.0）min;阻断组术中出血量平均（240.4±12.6）ml,手术时间（100.0±40.6）min,两组比较出血量差异明显（P〈0.05）,手术时间无显著差异（P〉0.05）。术后均未出现严重并发症,术后平均住院6.5 d,恶性肿瘤术后随访3年未见切口及腹腔内转移。结论腹腔镜肝切除术是一种微创方法,且是安全、可行的。

Objective To evaluate the minimally invasive method and therapeutic efficacy of the complete laparoscopic hepatectomy. Method During June 2005 to August 2009, 13 cases underwent complete laparoscopic hepatectomy, including 3 cases of primary hepatocellular carcinoma, 2 eases of liver cutaneous cyst, 1 case of metastatic hepato-tumor, 4 cases of liver hemangioma, 2 cases of liver focal nodular hyperplasia coexisting cholelithiasis and 1 case of hepatocellular adenoma. Results The laparoscopic hepatectomy was accomplished successfully in all the patients without converting to open surgery. The mean operation time was （ 120.0 ± 60. 0） minutes, the mean blood loss was （ 612.8 ± 24.6 ） ml in the un-block group. The mean operation time was （100.0 ± 40.6）minutes, the mean blood loss was （240.4 ± 12.6）ml in the block group. There was significant difference in the mean blood loss. No severe complication occurred after the operation. The mean postoperative hospital stay was 6.5 d. The patients were followed up. No recurrence of carcinoma, or tumor implantation at the puncture site was found in this series. Conclusion Laparoscopic hepatectomy is a minimally invasive method with the advantages of safety and feasibility.