全腹腔镜前入路右半肝切除治疗肝细胞癌

Pure laparoscopic right hemihepatectomy for hepatocellular carcinoma via the anterior approach

目的探讨全腹腔镜前入路右半肝切除治疗肝细胞癌的可行性及安全性。方法回顾性分析2013年12月至2016年12月于佛山市第一人民医院施行全腹腔镜前入路右半肝切除术的5例肝细胞癌患者的临床资料。统计患者的手术时间、出血量、输血量、肿瘤手术切缘、住院时间、并发症以及近期疗效等指标。结果5例患者均成功完成全腹腔镜前入路右半肝切除术，无一中转开腹。患者平均手术时间6．0（5．0～8．0）h，平均出血量340（110～600）ml，术中无一输血；平均肿瘤手术切缘2．4（1．0—4．5）cm，术后平均住院时间7（4～15）d。术后随访时间22（2—38）个月，有3例患者术后发生并发症，腹腔积液、胸腔积液、腹腔积液合并胆漏各1例，经穿刺引流治疗后均痊愈。无一例患者出现肝功能衰竭、肿瘤复发或死亡。结论全腹腔镜前入路右半肝切除具有创伤小、术后恢复快等优势，更加符合肿瘤根治原则。在技术上，治疗肝细胞癌具有一定的可行性和安全性，近期疗效满意。

Objective To study the feasibility and safety of pure laparoscopic right hemihepatecto- my for hepatocellular carcinoma via the anterior approach. Methods The data of five patients with hepatocellular carcinoma who underwent pure laparoscopic right hemihepatectomy at the First People＇s Hospital of Foshan between December 2013 and December 2016 were retrospectively analyzed. Patients＇operation time, blood loss, blood transfusion rate, surgical margins, hospital stay, complication and short term outcomes were reviewed. Results All the five patients completed pure laparoscopic right hemihepatectomy without conversion to open surgery. The average （range） operation time was 6.0 （5 - 8 ） h. The average blood loss was 340 （110 - 600） ml. No patient received blood transfusion. The average surgical margin was 2.4 （1 -4.5） cm. The average postoperative hospital stay was 7 （4 - 15） d. The average follow-up was 22 （2 -38） months. Three patients experienced postoperative complications, which included ascites, pleural effusion, and ascites accompanied by biliary leakage, respectively. The last patient recovered well from drainage. No liver failure, cancer recurrence or death was noted. Conclusions This study demonstrated that pure laparo-scopic right hemihepatotectomy via the anterior approach is a minimally invasive procedure which has the ad- vantage of fast postoperative recovery. It was feasible and safe to treat hepatocellular carcinoma with favorable short-term outcomes.