完全腹腔镜肝切除术在肝肿瘤治疗中的应用和评价

The clinical application and evaluation of completely laparoscopic hepatectomy for liver tumors

目的探讨完全腹腔镜肝切除术在肝肿瘤治疗中的安全性及临床效果。方法回顾性分析2010年12月至2012年9月期间在我科行完全腹腔镜下肝切除术的42例肝肿瘤的临床资料。结果 42例手术均获得成功,其中原发性肝癌35例、肝血管瘤5例,肝炎性假瘤2例。术式:左外叶切除(II,III段肿瘤)19例、左半肝切除(IVa,IVb段肿瘤)5例,V^VII段(V^VII段肿瘤)部分肝切除18例。手术时间30~290(90±30)min,术中出血30~1 000(350±80)mL,术后引流量为20~150(64±15)mL/d。术后引流管拔除时间2~5 d,下床活动时间术后第2~3天,2~3 d后胃肠道功能恢复,总住院时间5~12(8.5±1.7)d。未发生胆漏、大出血、气体栓塞等严重并发症,全组无死亡。随访35例肝细胞癌12个月以上,其中l例术后6个月、2例术后10个月出现肝内复发,其余均健在,均未见局部复发及腹壁戳孔种植性转移等。结论肝脏II、III、IVb、V^VII段的肿瘤行完全腹腔镜肝切除术是安全可行的,且短期随访效果良好,其他部位的肿瘤如遇操作困难可视情中转开腹。

Objective To explore the clinical safety and feasibility of completely laparoscopic hepatectomy for liver tumors.Methods The clinical data of 42 patients with liver tumors undergone completely laparoscopic hepatectomy from Dec.2010 to Sep.2012 were retrospectively analyzed.Results The laparoscopic liver resection of 42 patients with liver tumor were successfully performed,including 35 cases of hepatocellular carcinoma,5 cases of liver hemangioma,2 cases of inflammatory pseudo-tumor.Laparoscopic liver resection included 19 cases of left lateral lobectomy （lesions in Ⅱ,Ⅲ segments）,5 cases of left hemihepatectomy （in Ⅳa,Ⅳb segments）,and 18 cases of partial hepatectomy （in Ⅴ～Ⅶ）.The operating time was 30～290 （90 ± 30） min,the blood loss volume during operation was 30～1 000 （350 ± 80） mL,and the drainage volume 20～150 （64 ± 15） mL/d.The drainage tubes were removed 2～5 d after operation.The time to ambulation was 2～3 d after operation.The time of gastrointestinal recovery was 2～3 d after surgery,and the overall hospitalization was 5～12 （8.5 ± 1.7） d.No serious postoperative complications occurred such as bile leakage,massive bleeding,air embolism.There was no operative mortality.One case in six months and two in ten months had local tumor relapse during the followup period of over 12 months in 35 cases of hepatocellular carcinoma,the others had no local recurrence and abdominal wall hole planting metastasis.Conclusion Laparoscopic hepatectomy is a safe and feasible operation in liver tumors occurred in Ⅱ,Ⅲ,Ⅳb,Ⅴ～Ⅶ segments with good results during short-term follow-up,but immediate conversion to open surgery intraoperatively is considered in the cases of liver tumors occurred in other segments.