全腹腔镜肝切除术在治疗肝脏肿瘤中的应用价值

Laparoscopic liver tumor resection of clinical experience in 126 patients

目的探讨完全腹腔镜肝切除术在治疗肝脏肿瘤中的应用价值。方法回顾性分析2006年6月至2011年12月间126例施行完全腹腔镜肝切除术患者的手术时间、术中失血量、术后并发症等临床资料。男性87例，女性39例，年龄28～83岁，平均44．5岁。断肝方式为超声刀＋LigaSure联合分离法，结合腹腔镜下切割缝合器。术后病理诊断原发性肝癌45例，肝血管瘤58例，结肠癌肝转移23例，肝脏局限性结节状增生5例，肝脏炎性肉芽肿1例，肝脏腺瘤4例。手术术式包括：左半肝切除17例、左外叶切除34例、肝段切除22例、右半肝切除15例、局部切除59例（合并左半肝切除6例，合并左外叶切除5例，合并右半肝切除2例，合并肝段切除8例）。结果126例患者平均手术耗时142min（43～220min），术中出血量180ml（10～1250m1）。8例患者术后发生胆漏，经充分引流1～3周治愈。平均术后住院时间为6．2d（3～12d）。对恶性肿瘤患者术后平均随访18个月（12～46个月），肿瘤复发12例，其中4例因肿瘤复发转移死亡。结论在病例选择适当时，腹腔镜下肝切除术是一种安全、有效、微创的手术，可安全用于局部、肝段及半肝切除术，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 hepodectomy （LH）. Methods To explore the clinical application From June 2006 to December 2011, technology of completely laparoscopy the 126 cases of LH were performed, the data including operating time, blood loss and postoperative complications, etc, were analyzed retrospectively. The patients included 87 males and 39 female and they were 28-83 years old with an average age of 44. 5 years old. The parenchyma was transected using laparoscopic ultrasonic scalpel and ligasure, accomplished with endoscopic linear stapler. Of all the patients, the diseases performed LH including primary liver carcinoma （45 cases）, liver hemoangioma （58 cases）, colon carcinoma with livermetastasis （23 cases） , liver focar （ 5 cases ）, liver granuloma （ 1 case）, liver adenoma （ 4 cases ）. The operations included left hemihepatectomy （ n = 17 ）, left lateral lobectomy （ n = 34 ）, right hemihepatectomy （ n = 15 ）, segmentectomy （n = 22）, local resection （n = 59）. Results Of all the patients, mean blood loss was 180 ml （10-1250 ml）, mean surgical time was 142 minutes （43-220 minutes）, mean postoperative hospital day was 2. 2 days （3-12 days）. Postoperative complications including eight cases of bile leakage, recovered after !-3 weeks by appropriately draining. The patients with malignant tumor were followed up for 18 months （ 12- 46 months） , recurrence happened in 12 cases and four cases was died of recurrence and metastasis. Conclusions LH is a safe, feasible and effective procedure for the treatment of benign liver disease and malignant liver neoplasm as long as the patient is properly seiected, it should be recommended for radical resection of hepatocellular carcinoma.