超声引导下穿刺辅助腹腔镜肝实质内肿瘤切除

Ultrasound-guided puncture for laparoscopic resection of liver parenchyma tumor

目的探讨超声引导下细针穿刺肿瘤定位,辅助腹腔镜下肝实质内肿瘤切除的应用价值。方法对拟行腹腔镜下肝肿瘤切除的5例肝实质内肿瘤患者,术前行超声检查,确定肿瘤直径、肿瘤与肝表面距离、肿瘤与周围脉管的关系。在超声引导下选择肿瘤距离肝表面最近的位置,避开大血管和胆管,使用细针进行肿瘤穿刺定位并留置。确定肝拟定切除线时,按术前超声测量肿瘤半径,以细针入肝处为指引,超出肿瘤边界约2 cm拟定肝切除线。根据定位情况,按腹腔镜肝切除手术步骤进行手术。结果细针穿刺肿瘤定位可以确定肝实质内肿瘤位置,5例患者均根据细针穿刺辅助定位,成功实施完全腹腔镜下肝实质内肿瘤切除,所有患者均未发生严重并发症,未发生胆漏、出血。手术时间105~215 min,出血量50~500 ml,术后随访3~6个月,均未发现针道转移及其他并发症。结论超声引导下细针穿刺定位具有简便、经济、安全、定位准确等特点,对腹腔镜下肝实质内肿瘤的切除具有引导作用。

Objective To evaluate the clinical value of location with ultrasound-guided fine needle puncture for laparoscopic resection of liver parenchyma tumor. Methods A total of 5 cases of liver parenchyma tumor patients who underwent laparoscopic liver tumor resection, received preoperative ultrasound examination. We determined diameter of tumor,distance between tumor and liver surface,relationship between tumor and around vascular. The nearest location from liver surface to tumor was selected under ultrasound guidance,avoiding the nearby blood vessels and bile ducts,using a fine needle biopsy tumor localization and retention. Under ultrasound-guided,we chosen the location of the tumor recently from liver surface,avoiding the great vessels and bile ducts,using fine needle in tumor puncture positioning and lien. In accordance with tumor radius measured by preoperative ultrasound,the boundary lines were drawn more than 2 cm from the tumor. According to positioning,operations were carried out in accordance with the steps of laparoscopic liver resection surgery. Results The location of liver parenchyma tumor can be determined by fine needle puncture, all patients were successfully completed with laparoscopic liver parenchyma tumor resection,uncontrollable intraoperative and postoperative complications did not occur. The operation time of 105-215 min, the bleeding 50-500 ml, postoperative follow-up of 3-6 months after metastasize found no needle and other complications. Conclusions Location with ultrasound-guided fine needle puncture is simple,easy to operate,economic and safe. It plays a role in guiding role in laparoscopic liver parenchyma tumor resection.