精准肝切除理念在腹腔镜下Ⅰ型肝血管瘤剥除术中的应用

Application of the concept of precise hepatectomy in laparoscopic hepatic hemangioma dissection of typeⅠhepatic hemangioma

目的探讨精准肝切除理念在腹腔镜下Ⅰ型肝血管瘤剥除术中的应用价值。方法采用描述性病例研究方法,回顾分析2017年1月至2020年3月因Ⅰ型肝血管瘤收住该院采用腹腔镜下行肝血管瘤剥除术治疗的54例患者的临床病历资料。其中男15例、女39例,年龄24~70岁,平均(48.09±11.96)岁。血管瘤位于Ⅱ段5例、Ⅲ段者8例、Ⅳ段者7例,Ⅴ段者11例、Ⅵ段者13例、Ⅶ段者7例、Ⅷ段者3例,血管瘤直径5.1~10.4 cm,平均(7.01±1.42)cm。结果所有患者均顺利完成手术,其中4例合并胆囊结石、1例合并胆囊息肉同时行腹腔镜下胆囊切除术。手术时间(137.50±17.26)min,术中出血量(157.04±40.22)mL,术后出现胆漏3例,继发肺部感染4例,其余患者无出血、肝功能衰竭、腹腔感染、切口感染等相关并发症的发生,住院时间(11.24±2.11)d,住院费用(2.31±0.34)万元。结论精准肝切除理念指导下腹腔镜下Ⅰ型肝血管瘤剥除术安全可行、可临床推广。

Objective To explore the application value of the precise hepatectomy concept in laparoscopic hepatic hemangioma dissection of typeⅠhepatic hemangioma.Methods A descriptive case study method was used to retrospectively analyze the clinical medical records of 54 patients who underwent laparoscopic hepatic hemangioma dissection in this hospital from January 2017 to March 2020.Among them,there were 15 males and 39 females,aged from 24 to 70 years,with an average age of(48.09±11.96)years.There were 5 cases of hemangioma in stageⅡ,8 cases in stageⅢ,7 cases in stageⅣ,11 cases in stageⅤ,13 cases in stageⅥ,7 cases in stageⅧ,3 cases in stageⅨ,and the diameter of hemangiomas was 5.1-10.4 cm,average(7.01±1.42)cm.Results All the patients completed the operation successfully.Among them,4 patients with gallbladder stones and 1 patient with gallbladder polyps underwent laparoscopic cholecystectomy at the same time.The operative time was(137.50±17.26)min,intraoperative blood loss was(157.04±40.22)mL,postoperative biliary leakage was found in 3 patients,and secondary pulmonary infection occurred in 4 patients.The other patients had no bleeding,liver failure,abdominal infection,incision infection and other related complications.The hospitalization time was(11.24±2.11)days,and the cost of hospitalization was(2.31±0.34)million yuan.Conclusion The concept of precise hepatectomy is safe and feasible under the guidance of laparoscopic in resection of typeⅠhepatic hemangioma and is worth of clinical promotion.