腹腔镜肝血管瘤剥离术手术入路的改进

Improvement on surgical approach for laparoscopic hemangioma dissection

目的探讨腹腔镜下肝血管瘤剥离术的手术途径及其临床疗效。方法回顾性分析2018年8月至2019年12月期间苏州大学第三附属医院收治的40例肝血管瘤患者的病例资料。改进的技术要点在于剥离途径的角度、方位,使其充分暴露瘤体下极假包膜。结果40例患者均成功实施了腹腔镜下肝血管瘤剥离术。手术时间(90.3±32.3)min;术中出血量(50±500 ml);肝门阻断时间(12.5±35.4)min。术后第1天引流量10-150 ml,逐渐减少第3天<30 ml予以拔除。平均住院时间(5.5±2.7)d。血清ALT、AST、总胆红素和前白蛋白水平,术后第1天和第3天与术前比较差异有统计学意义(t=-5.481,-4.182,-2.235,9.722,P<0.05),而术后7d与术前比较差异无统计学意义(20.167,-1.392,1.000,-2.531,P〉0.05)。结论肝血管瘤剥离术其技术要点在于剥离途径的角度、方位,使其充分暴露瘤体下极假包膜。具有操作简单、安全、肝门阻断时间短、正常肝组织保留多、对肝功能影响小等优点。

Objective To discuss the surgical approach and the clinical effect of laparoscopic enucleation for hepatic hemangioma(HH).Methods Forty HH patients admitted in the Third Affiliated Hospital of Soochow University between Aug 2018 and Dec 2019 were analyzed.The technical knowhow involved is to make a good explosure of the pseudocapsular HH from undemeath.Herewith a process of HH enucleatoin started.Results All the 40 patients undergone total laparoscopic hepatectomy successfully.The operative time was(90.3±32.3)min,the intraoperative blood loss was(50±500)ml,the time of hepatic block was(12.5±35.4)min.The volume of postoperative drainage was 10-150 ml on the first postoperative day,and was gradually reduced to<30 ml on the third day after the operation.All patients were up and about from post-op day 2.The length of stay after operation was(5.5±2.7)d.There were significant differences in ALT、AST、TBIL and prealbumin in 1 and 3 days after surgery(seperately,t=-5.481,-4.182,-2.235,9.722,all P<0.05),before back to normal on day 7(seperately t=0.167,-1.392,1.000,-2.531,all P>0.05).Liver function recovered to normal in 7 days after surgery.Conclusion New approach breaks the traditional stripping method and makes the procedure simple,safe,lessly disturb the liver function.