完全腹腔镜肝切除治疗肝脏恶性肿瘤的临床研究

The clinical study of the treatment of malignant hepatic neoplasm with laparoscopic hepatectomy

目的近年来,随着技术的不断成熟和设备的不断改进,腹腔镜肝切除(laparoscopic hepatectomy,LH)在国内外已得到一定的推广应用,但LH治疗肝脏恶性肿瘤的报道仍然较少。本研究通过回顾性分析探讨腹腔镜肝切除LH治疗肝脏恶性肿瘤的技术要点及安全性。方法 2002年6月至2008年12月由同一手术组施行的腹腔镜肝切除手术116例,其中肝细胞癌95例,肝门部胆管癌3例,肝内胆管细胞癌5例(包括肝内胆管结石癌变1例),肝脏转移癌12例,肝囊腺癌1例,其中男77例,女39例,平均年龄48.7(28～71)岁。结果手术方式包括解剖性肝55例,非解剖性切除61例。手术时间75～310min,平均(216±87)min。出血量50～1500ml,中位数250ml。116例病人中23例输血,输血量400～800ml。5例中转开腹,其中1例死亡。中转开腹5例,其中1例术中死亡。8例术后出现少量胆漏,经引流后愈合;11例出现少量腹水(均为肝功能ChildB级),经对症治疗消失。术后住院时间3～18d,平均(6.1±1.9)d。术后随访6～83个月,平均(28.1±10.5)个月,复发12例,未发现腹腔及穿刺孔转移。结论 LH是一种治疗肝脏恶性肿瘤安全有效的方法,值得在临床中进一步推广。

Objective Resently,laparoscopic hepatectomy had been widely used with the improvement of the equipment and technique.But the article of laparoscopic hepatectomy for malignant liver diseases was still comparatively rare.This study discusse the technique key points and safety of laparoscopic hepatectomy （LH）for malignant hepatic neoplasm.Methods From June 2002 to Dec 2008,116 consecutive cases of malignant hepatic neoplasm,included 77 males and 39 Females, with a mean age of 48.7（28-71）age,underwent LH in our department.All of the operations were performed by the same surgical team.The preoperatively diagnosis included 95 cases of HCC,12 cases of liver metastasis,4 cases of intrahepatic cholangiocarcinoma,3 cases of hilar cholangiocarcinoma and 1 case of hepatic cystadeno-carcinoma.Results Laparoscopic hepatectomies succeeded in 111 cases and the other 5 cases were coverted to open resections,included 55 anatomic and 61 unanatomic hepatectomies.The operative time was 216±87（range： 75-310） minutes.The median intraoperative blood loss was 250（rang：50-1500）ml.The postoperative hospital stay was 6.1±1.9 days（range：3-18）.1 patient died of gas embolism during the operation.biliary fistula occurred in 8 cases and ascites in11 cases postoperatively,which were cured for several days.By 6-83 months of follow up,recurrence in liver occurred in 12 cases.There was no peritoneum and port metastasis.Conclusions Our experience indicates that LH is a safe and feasible method for the treatment of malignant liver neoplasm with good short and middle term outcomes,but further prospective study are needed to evaluate this procedure.