腹腔镜左肝外叶切除术操作要点及解剖基础研究

The operating points and anatomical basis of laparoscopic hepatic left lateral lobectomy

目的：探讨腹腔镜左肝外叶切除术操作要点及解剖基础。方法选取2014年4—12月于景德镇市第一人民医院行腹腔镜左肝外叶切除术的肝脏疾病患者10例，术后查阅文献并结合手术经验总结腹腔镜肝左外叶切除术的操作要点与解剖注意事项。结果患者左肝外叶静脉均为Ⅲ段属支，其中单支型7例，双支型3例；属支距切断面前缘0.6~1.7cm，平均（1.2±0.3）cm；属支距膈面0.5~1.7cm，平均（1.2±;0.2）cm；均顺利完成手术；手术时间166~254min，平均（195.5±13.8）min；术中出血量105~208ml，平均（108.2±20.2）ml；术后拔除腹腔引流管时间2~6d，平均（3.3±0.5）d；住院时间5~15d，平均（8.5±2.2）d；患者术后均未发生严重并发症。结论充分掌握手术操作要点并明确左肝外叶解剖方法后，腹腔镜左肝外叶切除术可推广至各阶层医院应用。

Objective To explore the operating points and anatomical basis of laparoscopic hepatic left lateral lobecto-my. Methods A total of 10 hepatic disease patients treated with laparoscopic hepatic left lateral lobectomy were selected in the First People＆#39;s Hospital of Jingdezhen from April to December 2014,operating points and the anatomical considerations of laparo-scopic hepatic left lateral lobectomy were summarized by literature review and operative experience. Results Patients with left extrahepatic leaf veins were Ⅲ section genus branch,single branch type was 7 cases,double branch types was 3 cases;genus branch distance to cutting faces leading edge was 0. 6 ~ 1. 7cm,average at（1. 2 ± 0. 3）cm;genus branch distance to dia-phragmatic surface was 0. 5 ~ 1. 7cm,average at（1. 2 ± 0. 2） cm;operation were completed smoothly;operation time were 166 ~ 254min,average at（195. 5 ± 13. 8）min;intraoperative blood loss were 105 ~ 208ml,average at（108. 2 ± 20. 2）ml;postoperative peritoneal cavity drainage tube pull out of time were 2 ~ 6d,average at（3. 3 ± 0. 5）d;hospitalization time were 5 ~ 15d,average at（8. 5 ± 2. 2）d;no one occurred postoperative serious complications. Conclusion Fully grasp the operat-ing points and clear anatomical methods of hepatic left lateral,laparoscopic hepatic left lateral lobectomy application can be ex-tended to all levels of hospital.