全腹腔镜下特殊部位肝脏肿瘤切除术经验总结

Clinical evaluation of laparoscopic hepatectomy for liver tumors in Couinaud Ⅰ,Ⅳa,Ⅶ and Ⅷ

目的探讨全腹腔镜下特殊部位肝脏肿瘤切除术的临床应用经验。方法回顾性分析2009年7月至2014年12月福建医科大学附属第一医院收治并行全腹腔镜下肝脏肿瘤切除术的56例肝脏Ⅰ、Ⅳa、Ⅶ、Ⅷ段肿瘤患者的临床资料，其中肝血管瘤5例、结直肠癌肝转移4例、肝腺瘤6例、肝细胞癌32例、肝脏局灶性结节增生8例、肝脏错构瘤1例。肝功能均为Child—PughA级。随访采用门诊或住院复查、电话和信件相结合的方式，随访截至2015年1月。结果56例患者中，1例中转开腹，55例完成全腹腔镜下肝脏肿瘤切除术。肿瘤最大径3．0～9．0cm，平均（5．7±3．4）cm；手术时间55～260min，平均（115±46）min；术中出血量20～550ml，平均（181±135）ml；术后住院时间5—10d，平均（7．1±1．5）d。术后有4例（7．1％）出现并发症，经保守治疗痊愈，无围手术期死亡病例。术后1个月47例患者已参加全职工作。术后发生肿瘤复发转移9例，恶性肿瘤患者术后1年总体生存率和无瘤生存率分别为100％和85．7％。结论全腹腔镜下肝脏肿瘤切除术可安全、有效地应用于经恰当选择的肝脏特殊部位肿瘤。

Objective To summarize the clinical experience of laparoscopic hepatectomy （LH） for liver tumors in Couinand Ⅰ,Ⅳa,Ⅶ and Ⅷ segment. Methods Fifty-six patients with tumor in Couinaud Ⅰ,Ⅳa,Ⅶ and Ⅷsegment underwent LH in Department of Hepatobiliary Surgery, the First Affiliated Hospital of Fujian Medical University from July 2009 to December 2014. The pathological diagnoses were hepatic hemangioma （5 patients ）, eoloreetal cancer metastasis to the liver （4 patients ）, hepatic adenoma （6 patients）, hepatoeellular carcinoma （ 32 patients ） , focal nodular hyperplasia （ 8 patients ） and liver harmatoma（ 1 patient）. The liver function of all patients was Child-Pugh class A. All patients were followed up by several kinds of methods which included outpatient or inpatient review, telephone and mail until January 2015. Results LH was converted to open hepatectomy in one patient,and tumor resection by LH was successful in other patients. The mean diameter of tumor was （ 5.7±3.4 ）cm （ range 3 - 9 cm）. The mean operative time was （115±46）min （range 55 -260 rain）. And the mean estimated intraoperative blood loss was （ 181 ± 135 ） ml （ range 20 - 550 ml ）. The postoperative hospital stay was （ 7. 1 ±1.5 ） days （range 5- 10 days）. Postoperative complications occurred in 4 patients （7. 1 percent） and resolved with conservative management. There was no perioperative deaths. At the l-month follow-up, 47 patients had returned to full-time work. A total of 9 patients had evidence of recurrence after operation. The one-year overall and disease-free survival rates of patients with malignant tumor were 100 percents and 87. 5 percents, respectively. Conclusion LH for tumors in segment Ⅰ,Ⅳa,Ⅶ and Ⅷ is safe and effective.