3D腹腔镜下前入路经肝正中裂劈开儿童肝尾状叶肿瘤切除术

Three-dimensional laparoscopic resection of caudate lobe hepatic tumor via an anterior approach in children

目的探讨儿童3D腹腔镜下前入路经肝正中裂劈开肝尾状叶切除术治疗儿童肝尾状叶巨大肿瘤的疗效和可行性。方法回顾性分析2019年12月湖南省儿童医院1例肝尾状叶肿瘤切除术患儿临床资料。患儿女,2岁,12 kg,术前诊断为肝尾状叶占位,体积60 mm×41 mm×50 mm。患儿家属签署知情同意书,符合医学伦理学规定。采用3D腹腔镜下前入路经Cantlie线将肝正中裂劈开,切除尾状叶肿瘤。结果手术过程顺利,术中阻断右半肝血流15 min,全肝血流阻断3次,时间15 min,术中出血量200 mL,输红细胞1 U。术后常规给予抗感染、抑酸、护肝、营养支持治疗。术后8 d复查腹部增强CT提示肝中静脉下方有低密度影,肝肾间隙少量积液,门静脉血流通畅,肝内胆管无扩张。病理学检查结果示局灶结节性增生。术后第13天恢复顺利出院。结论针对儿童肝尾状叶肿瘤,3D腹腔镜下前入路经肝正中裂劈开肝尾状叶肿瘤切除术安全性高、创伤小、出血量少,是一种新的尾状叶切除手术入路,应用在累及腔静脉旁部且向上挤压肝静脉的巨大尾状叶肿瘤中是可行的。前入路经肝正中裂劈开是腹腔镜下尾叶肿瘤切除的一种有效入路,经过术前仔细规划、术中精细解剖以及术后有效管理,在肝脏良性肿瘤切除中安全可行。

Objective To explore the safety and efficacy of three-dimensional(3D)laparoscopic resection of caudate lobe hepatic tumor in children.Methods The clinical data were analyzed retrospectively for a 2-year-old girl with caudate lobe hepatic tumor at Hunan Children s Hospital in December 2019.Her body weight was 12 kg and the tumore had a size of 60 mm×41 mm×50 mm.Via an anterior approach,3D laparoscopic resection was employed for splitting the median hepatic fissure through Cantlie line.Results During operation,right half of hepatic blood flow was blocked for 15 min and whole hepatic blood flow blocked thrice for 15 min each.The volume of intraoperative blood loss was 200 mL and 1 unit of red blood cell transfused.She received conventional treatments of anti-infection,anti-acid,hepatic protection and nutritional supports.At Day 8 post-operation,abdominal enhanced computed tomography(CT)showed low-density opacity under middle hepatic vein,minimal effusion in hepatorenal space,unobstructed portal vein blood flow and no dilatation of intrahepatic bile duct.Pathological examination showed nodular hyperplasia.At Day 13 after operation,she was discharged smoothly.Conclusion For pediatric caudate lobe hepatic tumor,3D laparoscopic resection is both safe and mini-invasive.It is also feasible for tumors involving vena cava and compressing hepatic vein.