腹腔镜循肝中静脉前入路解剖性右半肝切除35例临床分析

Laparoscopic anatomical right hepatectomy guided by middle hepatic vein in anterior approach: a clinical analysis of 35 cases

目的探讨腹腔镜循肝中静脉前入路解剖性右半肝切除的手术疗效及安全性。方法回顾性分析2015年3月至2017年3月湖南省人民医院肝脏外科35例行腹腔镜循肝中静脉前入路解剖性右半肝切除术患者的临床资料。结果所有患者经术后病理切片明确诊断:肝细胞癌12例(34.3%),肝内胆管细胞癌6例(17.1%),血管平滑肌瘤9例(25.7%),局灶结节性增生3例(8.6%),肝内胆管结石5例(14.3%)。术中情况:无中转开腹,手术时间(268.7±42.3)min,出血量(356.2±138.6)mL。术后情况:术后平均住院(7.8±1.6)d,出现腹腔积液1例(Clavien-Dindo分级I级),胆漏2例(Clavien-Dindo分级II级),胸腔积液合并肺部感染2例(Clavien-Dindo分级II级),均予以保守治疗后康复出院。结论腹腔镜循肝中静脉前入路解剖性右半肝切除术是一种安全的、有效的手术方式。

objective To investigate the clinical effcacy of laparoscopic anatomical right hepatectomy guided by middle hepatic vein. Methods The clinical data of 35 patients undergone anatomical right hepatectomy from Mar. 2015 to Mar. 2017 were retrospectively analyzed. Results All patiens were confrmed by pathology, the postoperative pathological results showed that： hepatocellular carcinoma was found in 12 patients （34.3%）, intrahepatic cholangiocarcinoma in 6 patients （17.1%）, vascular smooth muscle in 9 patients （25.7%）, focal nodular hyperplasia in 3 patients （8.6%）, hepatolithiasis in 5 patients （14.3%）. There was no conversion to laparotomy, the operative time was （268.7±42.5） min and intraoperative blood loss was （356.2±138.6） mL. Postoperative complications included ascites （Clavien-dindo grade class I） in 1 patient, bile leakage （Clavien-dindo grade class II） in 2 patients, pleural effusion combined with pulmonary infection （Clavien-dindo grade class II） in 2 patients. The average length of postoperative hospitalization was （7.8±1.6） d. Conclusion Laparoscopic anatomical right hepatectomy guided by middle hepatic vein in anterior approach is a safe and feasible method.