Laennec入路在腹腔镜解剖性右半肝切除术中的应用价值

Application value of Laennec approach in laparoscopic anatomical right hemihepatectomy

目的探讨Laennec入路在腹腔镜解剖性右半肝切除术中的应用价值。方法采用回顾性描述性研究方法。收集2020年5―7月南京医科大学康达学院第一附属医院收治的2例行Laennec入路腹腔镜解剖性右半肝切除术女性病人的临床病理资料;年龄分别为51岁和57岁。观察指标:(1)手术情况。(2)术后及随访情况。采用门诊和电话方式进行随访,了解病人术后生存及肿瘤复发情况。随访时间截至2020年12月。计数资料以绝对数表示。结果(1)手术情况:2例病人均成功施行Laennec入路腹腔镜解剖性右半肝切除术,无中转开腹。手术时间分别为180 min和185 min,术中出血量分别为200 mL和400 mL,均无术中输血。术中均未放置胃肠减压管。(2)术后情况:2例病人均在术后第1天开始进食流质食物,术后第2~3天下床活动。2例病人术后均未发生胆汁漏及出血,均发生不同程度的胸腔积液和腹腔积液,其中1例因呼吸困难行右侧胸腔穿刺置管引流术后好转,1例保守治疗后痊愈。2例病人无围术期死亡,术后住院时间分别为13 d和11 d。术后病理学检查结果证实:1例为肝血管瘤,1例为原发性肝癌;肝静脉Ⅴ、Ⅵ、Ⅶ、Ⅷ段分支均存在Laennec膜,且与静脉间存在间隙。2例病人术后分别获得7个月和5个月随访,随访期间均生存,肿瘤均未复发。结论行Laennec入路腹腔镜解剖性右半肝切除术安全、可行。

Objective To investigate the application value of Laennec approach in laparoscopic anatomical right hemihepatectomy(LARH).Methods The retrospective and descriptive study was conducted.The clinicopathological data of 2 female patients who underwent LARH via Laennec approach in the First Affiliated Hospital of Kangda College of Nanjing Medical University from May to July 2020 were collected.The two patients were 51 and 57 years old,respectively.Observation indicators:(1)surgical situations;(2)postoperative situations and follow-up.Follow-up using outpatient examination and telephone interview was conducted to detect post-operative survival and tumor recurrence of patients up to December 2020.Count data were repre-sented as absolute numbers.Results(1)Surgical situations:2 patients successfully underwent LARH via Laennec approach,without conversion to open surgery.The operation time was 180 minutes and 185 minutes,and the volume of intraoperative blood loss was 200 mL and 400 mL,respectively.No blood transfusion or gastrointestinal decompression was performed in either patient.(2)Postoperative situations and follow-up:2 patients began to take liquid diet on the first day and out-of-bed activities on the postoperative second to third day.There was no postoperative bile fistula or bleeding,but different degrees of peritoneal and pleural effusion occurred to the 2 patients after operation.One case was improved after right-sided thoracentesis and chest tube drainage due to dyspnea,and the other case was cured after conservative therapy.There was no perioperative death.The duration of postoperative hospital stay of 2 patients was 13 days and 11 days,respectively.Results of pathological examination showed 1 case of hepatic hemangioma and 1 case of primary liver cancer,respectively.The Laennec capsule was observed on the hepatic vein branches of segmentⅤ,Ⅵ,Ⅶ,Ⅷ,and the gap existed between the Laennec capsule and the hepatic vein.Two patients were followed up for 7 months and 5 months,respectively.They survived during the follow-up,without tumor recurrence.Conclusion It is safe and feasible to perform LARH by Laennec approach.