荧光腹腔镜下肝正中裂劈开入路中央型肝肿瘤切除术探讨

Fluorescent guided laparoscopic central hepatic tumor resection via anterior transhepatic approach

目的探讨荧光腹腔镜下肝正中裂劈开入路中央型肝肿瘤切除术的安全性及可行性。方法回顾性分析2017年4月至2020年4月期间在湖南省人民医院肝胆胰微创外科接受荧光腹腔镜下肝正中裂劈开入路中央型肝肿瘤切除术的3例患者的临床资料。结果 3例患者中包括肝细胞癌1例、肝局灶性结节增生2例,肿瘤最大径4~7 cm。3例患者均以全腹腔镜方式完成手术,手术时间为240~320 min,出血量为150~500 mL,无术中输血,术后住院时间10~30 d。术后发生胆汁漏1例,行腹腔镜肝切除术后愈合。3例患者术后分别获访8、36和25个月,随访期间患者均存活且无肿瘤复发。结论腹腔镜中央型肝肿瘤切除术的难度大、风险高,采取肝正中裂劈开入路行中央型肝肿瘤切除能最大限度保留肝脏实质。在腹腔镜肝切除经验丰富的中心,通过严格选择病例、术前精准评估和术中精细操作,此方法是安全可行的,联合吲哚菁绿荧光导航技术有助于术中精准肿瘤定位、引导切肝平面。

Objective To investigate the safety and feasibility of fluorescent guided laparoscopic central hepatic tumor resection via anterior transhepatic approach.Method We retrospectively analyzed the clinical data of three patients who underwent fluorescent guided laparoscopic central hepatic tumor resection via anterior transhepatic approach in Department of Hepatobiliary and Pancreas Minimally Invasive Surgery of Hunan Provincial People’s Hospital from April 2017 to April 2020.Results All the three patients completed the operation pure laparoscopically.Pathology results showed one case of hepatocellular carcinoma and two cases of focal nodular hyperplasia,the tumor size range from 4–7 cm.The operation time was 240–320 min,and the blood loss was 150–500 mL.There was no intraoperative blood transfusion.The postoperative hospital stay was 10–30 days.Postoperative bile leakage occurred in one patient,which was cured by laparoscopic hepatectomy.Three patients were followed up for 8,36,and 25 months,respectively,and all the patients survived and there was no tumor recurrence up to november 2020.Conclusions Laparoscopic resection of central hepatic tumor is difficult and risky.Anterior transhepatic approach can maximize the preservation of liver parenchyma.In hepatobiliary and pancreatic centers with high volume of laparoscopic hepatectomy,this method is safe and feasible after strict patient selection,accurate preoperative evaluation,and fine intraoperative skills.Indocyanine green fluorescence navigation technology is helpful to accurately locate tumor during operation.