左侧半旋转体位下腹腔镜肝脏Ⅶ段部分切除术治疗肝脏良性病灶临床疗效分析

Effective of laparoscopic liver S7 segmentectomy with the patient in the left hemi-rotational decubitus position for resection of benign liver lesions

目的评估左侧半旋转体位腹腔镜下肝脏Ⅶ段部分切除术治疗肝脏良性病灶的临床效果。方法回顾性分析2019年1月至12月青岛大学附属医院肝脏外科收治的20例肝脏Ⅶ段良性病灶的临床资料。所有病人均采用左侧半旋转体位,接受了腹腔镜下以Ⅶ段为主肝部分切除手术。结果手术无中转开腹和二次手术,没有输库血(3例病人因血管瘤较大,术中收集了自体血回输)。病人术后无胆漏及出血,均顺利康复出院,平均住院时间9.6 d。结论位于肝脏Ⅶ段的良性病灶,即使大于5 cm,靠近右肝静脉,也能通过左侧半旋转体位充分显露病灶,结合戳卡的布局调整,降低手术难度,保证腹腔镜下安全的切除以肝脏Ⅶ段为主的良性病灶,使对开腹手术有顾虑的病人从微创手术中获益。

Objective To evaluate the clinical effect of laparoscopic partial resection of segmentⅦof the liver in the left hemi-rotational position for benign liver lesions.Methods The clinical data of 20 patients with segmentⅦbenign liver lesions admitted to the Department of Hepatic Surgery,Affiliated Hospital of Qingdao University from January to December 2019 were retrospectively analyzed.All patients underwent laparoscopic partial hepatectomy with segmentⅦpredominant liver in the left hemi-rotational position.Results There was no conversion to laparotomy,no second operation and no blood transfusion(3 patients had autologous blood transfusion due to large hemangioma).The patients had no bile leakage or bleeding after operation,and were successfully recovered and discharged,with an average hospital stay of 9.6 d.Conclusion Benign lesions located in segmentⅦof the liver,even if larger than 5 cm,close to the right hepatic vein,can be fully exposed through the left hemi-rotator position,combined with the layout adjustment of the troear,reduce the difficulty of surgery,ensure the safe laparoscopic resection of benign lesions mainly in segmentⅦof the liver,so that patients who have concerns about laparotomy benefit from minimally invasive surgery.