腹腔镜下以肝中静脉为引导的肝实质优先入路解剖性肝脏S8段切除的临床应用价值

Clinical application value of laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein

目的探讨腹腔镜下以肝中静脉为引导的肝实质优先入路解剖性肝脏S8段切除的临床应用价值。方法回顾性分析2017年5月至2019年12月期间于陆军军医大学新桥医院肝胆外科行腹腔镜下以肝中静脉为引导的肝实质优先入路解剖性肝脏S8段切除的8例患者的临床资料,分析其手术时间、术中出血量、术后并发症、术后住院时间等指标。结果所有患者经术后病理切片明确诊断:肝细胞癌6例,混合型肝癌2例。所有患者均顺利完成手术,无中转开腹,中位手术时间220 min(190~240 min),中位术中失血量230 mL(200~280 mL),术中未输血。术后中位住院时间8 d(7~12 d),术后无并发症发生。8例患者均获访,随访时间为10.5~31.7个月,中位随访时间为16.9个月。所有患者随访期间均未发生出血、胆汁漏等并发症,无再次手术患者,无死亡患者。结论腹腔镜下以肝中静脉为引导的肝实质优先入路解剖性肝脏S8段切除是安全、有效的,可缩短手术时间,提高手术安全性,降低手术操作难度。

Objective To investigate the clinical application value of laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein.Methods Clinical data of 8 patients who underwent laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein in Xinqiao Hospital from May 2017 to December 2019 were retrospectively analyzed.The operation time,intraoperative blood loss,postoperative complications,and hospitalization duration were observed.Results All patients were confirmed by pathology,the postoperative pathological results showed that:hepatocellular carcinoma was found in 6 patients,mixed hepatocellular carcinoma and cholangiocarcinoma was found in 2 patients.All patients completed the operation successfully without conversion to open surgery.The median operation time was 220 min(190-240 min),median blood loss was 230 mL(200-280 mL),and blood transfusion was not needed.The postoperative median hospital stay was 8 d(7–12 d).All the patients recovered well without severe complications.Eight patients were followed up for 10.5 to 31.7 months,with a median follow-up time of 16.9 months.During the follow-up period,none of them developed hemorrhage,bile leakage,and other complications.There was no reoperation or perioperative mortality during the follow-up.Conclusions The method of laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein is safe and effective.This method can shorten the operation time,improve the safety,and reduce the difficulty of operation.