腹腔镜解剖性右半肝切除治疗肝肿瘤16例分析

Laparoscopic anatomical right hemihepatectomy for liver tumor in 16 patients

目的探讨腹腔镜解剖性右半肝切除术在治疗肝脏肿瘤中的价值。方法回顾性分析2007年10月至2011年10月间在北京大学第三医院住院的16例肝肿瘤患者，因肝脏肿瘤行腹腔镜解剖性右半肝切除术，观察患者手术时间、术中失血量、术后并发症等。断肝方式为超声刀＋LigaSure联合分离法，结合腔镜下切割缝合器。结果术后病理证实原发性肝癌（PLC）7例，肝血管瘤6例，结肠癌肝转移2例，胰腺无功能神经内分泌癌肝转移1例。平均手术耗时310（260～450）min，术中出血量约550（220～1550）ml。3例术后发生胆漏，经充分引流2～3周治愈。平均术后住院时间为7（5～14）d。对肝脏恶性肿瘤患者术后随访15（12～52）个月，肿瘤复发4例，其中2例因肿瘤复发转移死亡。结论腹腔镜下解剖性右半肝切除术是一种安全、有效、微创的手术。其不但适用于良性肿瘤，也适用于恶性肿瘤，能达到根治要求。

Objective To explore the clinical application of laparoscopic anatomical right hemihepatectomy in the treatment of liver tumor. Methods From October 2007 to October 2011, 16 cases of laparoscopic anatomical right hemihepatectomy were performed. The data of operative duration, blood loss volume and postoperative complications, etc, were analyzed retrospectively. Parenchyma was transected with a laparoscopic ultrasonic scalpel and ligature and accomplished with an endoscopic linear stapler. Results Among them, postoperative pathologic examinations revealed primary liver carcinoma （n = 7）, liver hemoangioma （n = 6）, colon carcinoma with liver metastasis （n = 2） and pancreatic non-function neuroendocrine carcinoma with liver metastasis （n = 1 ）. The mean vohime of blood loss was 550 （200 - 1550） ml, mean surgical time 310 （260-450） minutes and mean postoperative hospital stay 7 （5 -14）days. Postoperative complications included 3 cases of bile leakage recovered after 2 - 3 weeks by appropriate draining. The patients with malignant tumor were followed up for 15 （12 -52）months. Recurrence occurred in 4 cases and another 2 died of recurrence and metastasis. Conclusions Laparoscopic anatomical right hemihepatectomy is a safe, feasible and effective procedure for the treatment of benign liver disease and malignant liver neoplasms in properly selected patients. It should be recommended for radical resection of hepatocellular carcinoma.