腹腔镜下双极射频Habib 4X辅助肝切除治疗原发性肝癌86例

Laparoscopic Bipolar Radiofrequency-assisted Hepatectomy for Primary Liver Cancer:Report of 86 Cases

目的探讨腹腔镜下双极射频Habib 4X辅助肝切除治疗原发性肝癌的安全性和可靠性。方法 2010年10月~2016年10月我科对86例肝癌行腹腔镜下双极射频Habib 4X辅助肝切除,规则性肝切除时沿分界线,不规则肝切除时在距离肿瘤边缘1~2 cm处采用Habib 4X消融后行肝切除术。结果 85例顺利完成腹腔镜下肝切除术,其中14例行解剖性左半肝切除术,31例行左肝外叶切除术,40例行不规则肝切除术;1例中转开腹。所有患者均未阻断第一肝门。手术时间80~330 min,(151±62)min;出血量10~400 ml,(105±83)ml,术中均未输注血制品。围手术期无死亡,无肝断面出血、胆漏、肝功能衰竭等术后严重并发症发生。术后住院5~22 d,(11±4)d。85例随访1~72个月,中位随访时间30个月,术后1年内复发7例(8.2%),随访期间死亡14例(16.5%)。结论腹腔镜下Habib 4X辅助肝切除治疗原发性肝癌安全、可行,值得临床推广。

Objective To investigate the safety and reliability of laparoscopic bipolar radiofrequency-assisted（Habib 4 X）hepatectomy for primary liver cancer. Methods From October 2010 to October 2016,clinical data of 86 patients with primary liver cancer who underwent laparoscopic hepatectomy by using the Habib 4 X device were retrospectively analyzed. Regular hepatectomy was performed after tumor ablation was employed with Habib 4 X along the dividing line and irregular hepatectomy was performed after tumor ablation was employed with Habib 4 X 1-2 cm away from the tumor. Results The operation was completed successfully in 85 patients,including 14 cases of anatomical left hepatectomy,31 cases of left lateral lobectomy of liver,and 40 cases of irregular hepatectomy. One patient was given a conversion to laparotomy. Pringle manoeuvre was not used. The operative time was 80-330 min（mean,151 ± 62 min） and the blood loss was 10-400 ml（mean,105 ± 83 ml）. None of the patients required intraoperative transfusion of red cells or blood products. No patient died during hospital stay. No patients experienced serious postoperative complications such as bleeding from liver resection margins,bile leakage,or liver function failure. The hospital stay after surgery was5-22 d（mean,11 ± 4 d）. The 85 patients were followed up for 1-72 months（median,30 months）. There were 7 cases（8. 2%）of tumor recurrence within 1 year after surgery and 14 dead cases（16. 5%） during the follow-up. Conclusion Laparoscopic hepatectomy with assistance of Habib 4 X device for primary liver cancer is safe,feasible and efficient,being worthy of clinical popularization.