模式化腹腔镜肝左外叶切除术治疗肝血管瘤的临床应用(附44例报告)

A modeling method of laparoscopic left lateral hepatic sectionectomy for liver hemangioma: with a report of 44 cases

目的:总结与介绍采用模式化腹腔镜肝左外叶切除术治疗肝血管瘤的临床经验。方法:分析2012年1月至2018年1月为44例肝血管瘤患者行模式化腹腔镜肝左外叶切除术的临床资料。手术分7步完成:(1)患者取分腿平卧位,三孔法操作;(2)悬吊肝圆韧带提拉肝左外叶;(3)沿镰状韧带左侧粗分出肝左外叶Glisson鞘;(4)腔镜直线切割闭合器离断肝左外叶Glisson鞘;(5)于肝脏膈面切开肝实质,粗分出肝左静脉;(6)腔镜直线切割闭合器离断肝左静脉,切除肝左外叶;(7)处理创面、放置引流、取出标本。结果:44例均完成模式化腹腔镜肝左外叶切除术,3例同时行胆囊切除术。肝血管瘤直径平均(8.9±2.1)cm;手术时间平均(119.2±45.6)min,术中出血量100(50,200)ml;术后平均住院(6.3±2.0)d;术后发生并发症2例,其中胸腔积液1例,保守治疗痊愈;盆腔积液1例,经穿刺引流后痊愈。结论:模式化腹腔镜肝左外叶切除术治疗肝血管瘤安全、有效,操作简便、易于推广,适于更多肝左外叶病变的治疗。

Objective： To summarize the clinical experience of a modeling method for laparoscopic left lateral hepatic sectionectomy（ LLLHS） in liver hemangioma. Methods： The clinical data of 44 patients with liver hemangioma who accepted LLLHS from Jan.2012 to Jan. 2018 in China-Japan Friendship Hospital were retrospectively analyzed. The procedures were carried out with the patients placed in supine position and the legs were separated. 3 Trocars were used in operation. The round ligament of liver was suspended to haulage the left lateral lobe. Along the left side of falciform ligament,the Glisson sheath was disclosed by harmonic scalpel,then transected with a linear cutter stapler. The left hepatic vein was disclosed and transected in the same way. Finally the left lateral lobe was resected. The hepatic cutting surface management,wound drainage and specimen removal were performed serially. Results： This modeling method for LLLHS was performed successfully in 44 cases,3 patients accepted cholecystectomy simultaneously. The mean diameter of liver hemangioma was（ 8. 9 ± 2. 1） cm. The mean operative time was（ 119. 2 ± 45. 6） min,the intraoperative blood loss was 100（ 50,200） ml. The postoperative hospital stay was（ 6. 3 ± 2. 0） d. Postoperative complications occurred in two patients. One patient suffered from postoperative pleural effusion and was cured by conservative treatment. One patient got pelvic effusion and was resolved by puncture drainage therapy. Conclusions： This modeling method of LLLHS is a safe and effective procedure for liver hemangioma patients. It is a convenient operation and easy to spread,and should be used extensively for more cases of left lateral hepatic diseases.