模式化腹腔镜肝左外叶切除术:附71例临床应用报道

A modeling method for laparoscopic left lateral segment liver resection:report of 71 cases

目的介绍一套模式化腹腔镜肝左外叶切除方法。方法分7步:(1)患者取平卧位,4孔法操作;(2)按序离断肝周韧带脉,,断游肝离角肝度左偏叶左;(;3()6超)切声割刀闭粗合分器离离出断Ⅱ肝段左及静Ⅲ脉段;(血7)管处蒂理;(创4)面切,割留闭置合引流器,离取断出Ⅱ标/Ⅲ本段。血结管果蒂20;(035)年超7声月刀～2粗01分0年离8出月肝,左共完静成71例手术,无中转。手术时间75±30.8 min,出血量58±36.4 ml,术后平均住院4.8±1.5 d。术后腹水2例,胆瘘1例,保守治愈。结论本"模式化"方法简便,安全、可行,重复性好,术中出血及术后并发症少,术者腔镜技术要求低,适合各级医院借鉴,利于腹腔镜肝脏切除术的普及和推广。

Objective To summarize the experience with a modeling method for laparoscopic left lateral segment liver resection（LLLR）.Methods The surgical procedures of LLLR were carried out with the patient placed in a supine position and 4 trocars placed on the abdomen.After complete dissociation of the left lobe,the segment II and III vascular pedicles were freed with a harmonic scalpel and transected with a linear cutter stapler.The left hepatic vein（LHV） was dissociated with a harmonic scalpel with a slightly left direction of liver dissection,followed by complete resection of the LHV and finally by wound surface management,specimen removal,wound drainage,and abdominal incision closure.Results Between July,2003 and August,2010,this modeling method for LLLR was performed successfully in 48 cases without conversion to laparotomy.The mean operation time was 75±30.8 min,blood loss was 58±36.4 ml,and length of postoperative hospital stay was 4.8±1.5 days.Postoperative complications occurred in 3 cases,including ascites in 2 cases and mild biliary leakage1 case,all cured conservatively.Conclusion This modeling method can simplify the surgical procedure of LLLR,reduce blood loss,and avoid air embolism due to vein injury.Being less technically demanding,this method can be safely performed in hospitals at various levels.