＂陈氏阻断、悬吊技术＂在腹腔镜下复杂肝癌切除中的应用

Application of "Chen's vascular occlusion technique and Chen's liver-hanging maneuver" in complex laparoscopic hepatectomy

目的探讨"陈氏阻断、悬吊技术"在腹腔镜复杂肝切除术中的应用体会。方法回顾性分析本中心2014年10月至2015年10月完成的19例全腹腔镜下复杂肝切除术病人的临床资料。结合术前相关检查,评估病变大小、位置与重要血管的毗邻关系等,采用"陈氏阻断、悬吊技术",完成腹腔镜下肝切除术。结果 19例手术均成功完成,手术方式包括右半肝切除11例,尾状叶切除2例,Ⅵa段切除1例,第Ⅶ段切除1例,Ⅷ段切除2例,联合肝脏离断和门静脉结扎的二步肝切除术(ALPPS)2例,手术均在全腹腔镜下完成。平均手术时间(164.36±44.34)min,术中出血量(338.64±142.96)ml,无中转开腹,无围手术期死亡,平均住院时间(6.97±3.72)d。结论复杂肿瘤的肝叶切除通过腹腔镜完成是安全可行的,结合"陈氏阻断、悬吊技术"应用于腹腔镜复杂肝切除有利于控制血流,减少出血,增加手术的安全性,利于手术的成功完成。

Objective To explore the application of Chen＇s technique in complex laparoscopic hepatectomy.Methods Clinical data of 19 patients who underwent complex laparoscopic hepatectomy from Oct.2014 to Oct.2015 were retrospectively analyzed.According to preoperation examination, we evaluated the size and location of the lesions and the relationship between the tumors and important vessels.The Chen＇s vascular occlusion technique and Chen＇s liver-hanging maneuver were applied to perform complete complex laparoscopic hepatectomy.Results All the 19 operations were successfully accomplished laparoscopically,which included 12 cases of right hemihepatectomy,2 cases of hepatic caudate lobectomy,1 case of segment Ⅵa hepatectomy,1 case of segment Ⅶ hepatectomy,2 cases of segment Ⅷ hepatectomy,and 1 case of ALPPS.The mean operative time was （164.36±44.34）min. Blood loss during the operation was （338.64±142.96）mL.None was converted to open surgery and no death occurred.Average hospital stay was （6.97±3.72）days.Conclusions Complex hepatectomy can be done under laparoscope safely.The hepatectomy combined with Chen＇s technique can improve the safety of operation,which benefits controlling the bleeding.