腹腔镜肝切除术中出血的处理

Measures for Hemorrhage in Laparoscopic Hepatectomy

目的探讨腹腔镜肝切除术中出血的处理方法。方法对22例肝脏病变实施腹腔镜肝切除术。其中原发性肝癌5例,肝血管瘤16例,肝转移癌1例。15例肿瘤位于左外叶,1例位于肝尾状叶,2例位于第Ⅳ段,4例位于肝脏第Ⅵ段;肿瘤平均直径为4 cm(2～10 cm)。手术方式包括腹腔镜肝左外叶切除术15例,不规则肝部分切除术6例,肝尾状叶左半切除术1例。结果 22例均在腹腔镜下完成手术,无中转开腹,无手术死亡。平均手术时间为115 min(65～142 min),平均术中出血量为450 mL(270～780 mL),平均术后住院时间为6.5 d(3～11 d)。结论控制肝脏断面出血是腹腔镜肝切除术的技术关键。

Objective To investigate the preventive measures for bleeding in laparoscopic hepatectomy. Methods The candidates for laparoscopic hepatectomy were 22 patients with live lesions, including 5 patients with primary liver cancer, 16 patients with liver hemangioma, and 1 patient with metastatic liver cancer. The tumors located the left lateral lobe in 15 cases, caudate lobe in 1 case, segment IV in 2 cases, and segment V[ in 4 cases. The mean diameter of tumors was 4 cm （2-10 cm）. The surgical approaches included the left lateral lobectomy （15 cases）, left lateral lobectomy of caudate （1 case）, and nonanatomic and wedge resection were performed in 6 cases. Results Twenty- two cases underwent laparoscopic liver resection, there were no conversion to open and operative death. The mean operative time was 115 min （65-142 min）, the mean blood loss was 450 mL （270-780 mL）, the mean length of hospital stay after operation was 6.5 days （3-11 days）. Conclusion Control liver section hemorrhage is a key technique in laparoscopic hepatectomy.