腹腔镜肝切除141例

Laparoscopic hepatectomy for liver neoplasms in 141 cases

目的探讨腹腔镜肝肿瘤切除的适应证、安全性及手术操作技术。方法2010年3月至2011年12月行141例腹腔镜肝肿瘤切除术。其中肝细胞癌107例，血管瘤25例，局灶结节性增生7例，错构瘤1例，胆囊癌1例。对其临床资料进行回顾性分析。结果所有病例均成功在腹腔镜下完成手术，无中转开腹。手术方式包括解剖性肝切除48例，不规则局部切除93例。其中，肿瘤位于单个肝段74例，跨肝段64例；多发肿瘤切除3例。平均手术时间（148±52）min，术中出血平均（216±178）ml，术后平均住院（7．1±1．1）d。1例术后发生胆漏，2例出现轻度腹水，余均未出现术后并发症。肝癌病人术后随访至今，5例肝内复发，1例大网膜转移，无死亡病例。结论腹腔镜肝肿瘤切除具备微创性、安全性、有效性等特点，值得推广应用。

Objective To summarize the clinical experiences of laparoscopie hepatectomy for liver neoplasms. Methods Between March 2010 and December 2011,141 patients,including 107 cases of hepatoeellular carcinoma,25 cases of liver hemangiomas, 7 cases of liver focal nodular hyperplasia, 1 case of carcinoma of gallbladder and 1 case of liver harmatoma,underwent laparoscopie hepatectomy in our unit. Results Laparoscopic hepatectomy was successfully performed on all 141 patients, including 48 anatomic and 93 un-anatomic hepatectomies. The lesions were located at single segment （n = 74）, and multiple segments （n = 64） respectively. Three cases were subjected to the resection of the multiple tumors. The operative time was （148 ± 52） min, the volume of blood loss during the operation was （216 ± 178） ml,and the mean postoperative hospital stay was （7. 1 ± 1. 1） days. Bihary fistula occurred in 1 case and ascites in 2 cases postoperatively. Five cases had local tumor relapse, 1 case had peritoneum metastasis and no death occurred in all patients during the follow-up period. Conclusion Laparoscopic hepatectomy is a safe and feasible operation with minimally surgical trauma.