腹腔镜左半肝切除术的临床应用研究

The study of clinical application of laparoscopic left hepatectomy

目的探讨应用腹腔镜手术完成左半肝切除术的可行性。方法腹部Trocar的置放同LC,剑突下Trocar的置放于左肋弓下距中线3cm。CO2气腹压力10～12mmHg。超声刀切断镰状韧带、冠状韧带、做左三角韧带,切除胆囊。肝门血流阻断方式分别采用间歇性阻断2例、不阻断7例、选择性阻断23例。从胆囊窝中点向肝门左侧方向,应用超声吸引刀、双极电凝等器械向肝实质内分离至肝门左侧方。解剖左肝管、左门静脉横部后,将其分别结扎切断。肝内分离结扎切断肝左静脉,切除左半肝。结果 32例均行左半肝切除、胆道探查、T管引流术。手术均获成功,手术时间150～390min,平均190min。出血量280～1100ml,平均550ml。术后胆漏3例,引流治愈。1例术后4d肝创面急性大出血,腹腔镜下止血成功。多发性肝脓肿1例,反复超声引导下肝穿,术后6个月治愈。膈下脓肿1例,超声引导下穿刺治愈。32例随访6～12个月,均健在,无复发。结论腹腔镜左半肝切除术可行,术后恢复快,但行此类手术应慎重,一要具备相应的设备器械,二要有开腹肝切除和腹腔镜手术经验的医师行此手术。

Objective To investigate the feasibility of laparoscopic left hepatectomy.MethodsOne trocar was put at the abdominal wall as in laparoscopic cholecystectomy,while the trocar under thexiphoid was at the left to the mdiddle line,Under CO2 pneum operitoneum（10-12 mmHg）,the falciformligament、coronary ligament、left triangular ligament and the gallbladder were cut by ultrasonic scalpel.Discontinued obstruction and selective obstruction of the liver blood stream were employed in one and twocases respectively,in the other case,no obstruction was carried out By using CUSA（Cavitron UltrasonicSurgical Aspirator）or electric coagulation,the liver parenchyma was separated from the midpoint of fossa ofthe gallbladder to expose the left hepatic portal.Afterwards,the left hepatic duct gars transvcrsa were cut andthen ligated and the left hepatic artery was cut and ligatcd to remove the left liver.Results 32 caseswere performed left half liver excision,bile duct exploration,T-tube drainage.Performed successfully,theoperation time was 150 to 390min,average 190min.The bleeding was 280 to 1100ml,average 550ml.3cases were postoperative pylethrombosis,drainage cured.1 post-surgical liver wound mas-sivehaemorrhage on the forth day,laparoscopic acute bleeding successed.Multiple liver abscess in 1 case,Bultrasonic repeatedly guided by liver biopsy,six months after surgery cured.Between the abscess case,Bultrasonic next puncture cured.32 cases were followed up for 6 to 12 months,all health,no recurence.Conclusions Laparoscopy is fcasible for left hepatcctomy.Patients recover quickly after the procedure.Experience in open hcpatcctomy and laparoscopy arc necessary for this operation