超声刀联合微波止血分离器在腹腔镜小儿肝脏肿物切除术中的应用

Application of ultrasonic knife combined with microwave hemostatic separator in laparoscopic resection of pediatric liver mass

目的研究超声刀联合微波止血分离器在腹腔镜小儿肝脏肿物切除术中的应用效果,以期发展具有可行性及安全性的手术方式。方法河北医科大学第二医院小儿外科2016年6月至2021年3月收治的接受腹腔镜肝脏肿物切除术患儿15例,回顾性分析患儿的临床特征、肝脏肿物的位置、术前超声及影像学检查、手术处理策略、手术时间、术后复发率和并发症等情况。结果患儿年龄6月龄至14岁,其中男9例、女6例,15例均完全腹腔镜下肝脏肿物切除术获得成功,其中肝母细胞瘤10例、肝脏血管瘤3例、肝血管肉瘤1例、炎性假瘤1例。手术过程顺利,术中采用微波止血分离器联合超声刀切除肝脏肿物,术中出血量平均(50.76±7.56)ml,术后肝功能恢复时间平均(4.23±1.23)d,可以早期下床活动;术后5 d开始少量饮水,逐渐加量,恢复清淡饮食;无切口感染。所有患儿术中均预置肝门阻断带,但未行肝门阻断;术后均无出血发生;2例术后引流液呈胆汁样,每日50~100 ml,考虑胆瘘,经引流后,胆汁引流渐少,自愈;2例术后超声提示肝周少量积液,经1~3个月随诊消失。结论微波止血分离器联合超声刀可有效的应用于腹腔镜小儿肝脏肿物切除术,此方法减少术中出血量,降低术后肝功能损伤,缩短患儿术后恢复时间,是一种安全、有效的手术方式。

Objective To study the application effect of ultrasonic knife combined with microwave hemostatic separator in laparoscopic pediatric liver tumor resection,in order to develop a feasible and safe surgical method.Methods The Pediatric Surgery Department of the Second Hospital of Hebei Medical University was admitted to 15 children who underwent laparoscopic liver tumor resection from Jun.2016 to Mar.2021.The clinical characteristics,location and operation of the liver tumor were retrospectively analyzed.Pre-ultrasound and imaging examination,surgical treatment strategy,operation time,postoperative recurrence rate and complications etc.Results The children were 6 months to 14 years old.There were 9 males and 6 females.All 15 cases were successfully completed laparoscopic liver tumor resection,including 10 cases of hepatoblastoma,3 cases of hepatic hemangioma,and hepatic blood vessels.There was 1 case of sarcoma and 1 case of inflammatory pseudotumor.The operation process went smoothly.During the operation,a microwave hemostatic separator combined with an ultrasonic knife was used to remove the liver tumor.The average blood loss during the operation was(50.76±7.56)ml,and the average postoperative liver function recovery time was(4.23±1.23)days.Drink a small amount of water at the beginning of the day and gradually increase the amount to restore a light diet without incision infection.Hilar blocking bands were pre-installed in all children during the operation,but no hilar blocking was performed;no bleeding occurred after the operation;2 cases of postoperative drainage fluid was bile-like,50-100 ml per day,considering biliary fistula.After drainage,the bile drainage became less and healed by itself;2 cases of postoperative B-ultrasound showed a small amount of fluid around the liver,which disappeared after 1 to 3 months of follow-up.Conclusions The microwave hemostatic separator combined with ultrasonic knife can be effectively used in laparoscopic pediatric liver mass resection,and this method reduces the amount of intraoperative blood loss,reduces postoperative liver damage,and shortens the postoperative recovery time of children.It is a safe and effective surgical method.