完全腹腔镜肝叶切除术60例临床体会

Clinical experience of 60 cases of patients with total laparoscopic liver resection

目的探讨完全腹腔镜肝叶切除术的临床效果,总结手术经验,为临床提供参考。方法回顾性分析2012年2月~2015年4月于重庆市江津区中心医院肝胆外科行完全腹腔镜肝叶切除的60例患者的临床资料。其中行腹腔镜左肝外叶切除术者28例,行腹腔镜左半肝切除术者32例,观察患者的手术时间、术中出血量、术后并发症、术后住院时间等指标。结果 59例患者均顺利完成腹腔镜下肝叶切除术,1例中转开腹。平均手术时间为（150.9±35.4）min,平均术中出血为（220±23）m L,肿瘤均完整切除,无破裂。平均术后住院时间（5.1±0.9）d。随访（13.1±4.5）个月,所有患者均健在,肿瘤患者术后未发生转移、复发,术后3周,复查甲胎蛋白或癌胚抗原均降至正常水平,肝功能情况较术前均得到明显改善。结论腹腔镜肝叶切除术是一种安全、有效、微创的手术方式,但应严格掌握手术适应证,选择合适的手术方式,同时不断提高医生的手术技能。

Objective To explore clinical effect of liver resection by totallaparoscopic, summarizes the operation experience, and offer the reference for clinical. Methods Clinical data of 60 cases of patients with liver resection under laparoscopic from February 2012 to April 2015 in Department of Hepatobiliary Surgery, Jiangjin District Center Hospital of Chongqing City were retrospectively analyzed. 28 patients were given the resection of left liver lobe under laparoscopic, 32 patients were given resection of left liver under laparoscopic. The index of the patient＇s, such as operation time, intraoperative blood loss, postoperative complication, postoperative hospitalization time and so on were observed.Results 59 patients were completed total laparoscopic lobe resection successfully, only one patients of conversion to open surgery. Operation time was（150.9±35.4） min, intraoperative hemorrhage was（220±23） m L. Tumors were complete resection, and no broken. Postoperative hospitalization was（5.1±0.9） d. Follow-up for（13.1±4.5） months, all patients were alive, had not occurred postoperatively tumor metastasis and recurrence, 3 weeks postoperatively, AFP and CEA were down to normal levels, liver function was obviously improved. Conclusion Laparoscopic liver resection is a safe,effective and minimally invasive surgical procedure, but it is important to strictly master the operation indications,choose appropriate surgical procedure, and constantly improve the doctor＇s operation skills.