腹腔镜在肝脏外科的应用

The role of laparoscopy in the surgical treatment of liver diseases

目的探讨腹腔镜技术治疗肝脏疾病的应用前景。方法回顾性分析腹腔镜治疗５６例肝脏疾病的临床资料。结果腹腔镜肝癌切除２例成功，存活２０月。肝血管瘤切除２例成功，存活。不能切除的晚期原发性肝癌，行腹腔镜肝癌微波固化５例，顺利恢复，存活６－１６月；行腹腔镜门静脉插管５例，肝动脉结扎＋腹腔镜门静脉插管３４例。肝动脉插管＋腹腔镜门静脉插管４例，术后无并发症，早期经门静脉、肝动脉插管化疗，存活３－１２月。腹腔镜肝脓肿置管引流２例，无并发症，痊愈。腹腔镜肝囊肿开窗引流２例，无并发症，痊愈。结论腹腔镜肝切除术难度高，需探索。腹腔镜肝癌微波固化、肝动脉结扎木或肝动脉插管（化疗）术／或门静脉插管（化疗）术，可作为晚期不能切除的原发性肝癌患者的姑息治疗。腹腔镜肝脓肿置管引流术是取代剖腹肝脓肿引流术的有效方法。腹腔镜肝囊肿开窗术应作为肝囊肿的首选治疗方法。

Objective To evaluate the role of laparoscopy in the surgical treatment of liver diseases. Method The data of 56 patientswith liver disease underwent laparoscopic operation were analyzed retrospectively. Result Laparoscopic hepatectomy for hepaticcarcinoma (HC) were performed successfully on 2 patients. who kept alive for 20 months. Laparoscopic hepatectomy for liverhemangion,a were done successfully on 2 patients. rernaining alive. Five received laparoscopic microwave coagulo-necrotic therapyfor HC survived 6-12 months: Five patients received portal vein catheterization. 34 hepatic artery ligation plus portal veincntheterization. 4 portal vein catheterization plus hepatic artery cathcterization for unresectable advanced AC made good recoverwell. being alive tar 3~12 months. Two patients nuderwent laparoscopic-guided drainage of hepatic abscess and 2 laparoscopicfenestration for liver cyst recovered well, without complication. Conclusion Laparoscopic hepatectomy is very difficult on theexplorative stage. For palliative treatment of advanced unresectable HC. we can choose laparoscopic microwave coagulo-necrotictherapy. or hepatic artely ligation. hepatic artery catheterization and/or portal vein catheterization. Laparoscopic-guided drainage ofhepatic abscess may be an alternative method for open operation. Laparoscopic fenestration should be a first-choice method for livercyst.