无血流阻断全腹腔镜下解剖性肝切除术的临床应用体会

Clinical application experience of completely laparoscopic anatomical liver resection without bleeding control

目的探讨无血流阻断全腹腔镜下解剖性肝切除术的临床应用价值。方法回顾性分析解放军海军安庆医院2015年6月至2016年3月期间实施无血流阻断全腹腔镜下解剖性肝切除术的12例患者的临床资料,其中左肝内胆管结石9例,肝癌2例,肝血管瘤1例。结果 12例患者的手术均获成功,其中左肝外叶切除2例（Ⅱ＋Ⅲ段）,左半肝切除10例（Ⅱ＋Ⅲ＋Ⅳ段9例、Ⅴ＋Ⅶ＋Ⅷ段1例）;手术时间（210.75±65.83）min,术中出血量（296.67±373.74）ml,术后肛门首次排气时间（2.71±0.84）d,术后住院时间（13.92±5.98）d,住院费用（32 004.19±8 630.79）元。术后并发症发生3例,其中术后胃瘫1例、胆漏1例、肺部感染1例。所有患者术后随访3-15个月,其中2例肿瘤患者未复发或转移,肝内胆管结石未见结石残留及复发。结论无血流阻断全腹腔镜下解剖性肝切除术是安全有效的,是未来肝脏微创外科发展的方向之一。

Objective T o investigate the value of completely laparoscopic anatomical liver resection without bleeding control. Methods We retrospectively analyzed the clinical data of 12 cases of completely laparoscopic anatomical liver resection without bleeding control in our hospital from Jun. 2015 to Mar. 2016. Twelve patients included left intrahepatic bile duct calculi （9 cases） , liver cancer （ 2 cases） , liver hemangioma （1 case）. Results The surgery of 12 cases was successfully completed. Completely laparoscopic anatomical liver resection included left the outside leaf resection （ Ⅱ ＋ Ⅲ section） in 2 cases, left half liver excision （ Ⅱ ＋ Ⅲ＋ Ⅳ section） 9 cases, Ⅴ ＋ Ⅶ ＋ VID section in 1 case. The mea n operative time was （ 210. 75 土 65. 83） m in,blood losses were （ 296. 67 ± 373. 74） m l,Postoperative exhaust time was （2. 71 ± 0. 84） d,hospitalization after surgery was （ 13. 92 ± 5. 98） d ,treatment costs for the operative were （32 004. 19 ± 8 630. 79） yuan. Surgery complications occurred in 3 cases, lease was gastroparesis, 1 case was bile leakage and 1 case was pulmonary infection. In follow-up between 3 to 15 months, 2 cases of tumor patients were no recurrence or metastasis, none cases of stone patients were stone residue and recurrence. Conclusions Completely laparoscopic anatomical liver resection without bleeding control is safe and effective, is one of the future development of minimally invasive surgery of liver.