肝实质优先腹腔镜解剖性肝中叶切除术的应用体会

Application experience of laparoscopic anatomical central bisegmentectomy via hepatic parenchymal transection-first approach

目的:探讨肝实质优先腹腔镜解剖性肝中叶切除术的方法及应用技巧。方法:回顾分析2019年1月至2020年12月为16例肝癌患者行肝实质优先腹腔镜解剖性肝中叶切除术的临床资料,患者均签署知情同意书,符合医学伦理学规定。根据术前影像学检查、术中探查结果行肝实质优先腹腔镜解剖性肝中叶切除术。结果:16例患者均成功施行肝实质优先腹腔镜解剖性肝中叶切除术,无一例中转开腹。手术时间平均(137.5±25.7)min,出血量平均(130.3±47.4)mL,无术中输血病例。术后胸腔积液1例,胆漏2例,均通过穿刺引流后治愈。术后病理示15例肝细胞肝癌、1例腺癌(符合结肠癌肝转移),手术切缘均为阴性。术后平均住院(6.8±2.7)d。无围手术期死亡病例。结论:肝实质优先腹腔镜解剖性肝中叶切除术简化了鞘外肝蒂血流阻断,降低了术中出血、重要管道损伤的风险,更加符合肿瘤的“无瘤原则”,是简便、安全、有效的技术,具有良好的临床应用前景。

Objective:To investigate the operative method and technique of laparoscopic anatomical central bisegmentectomy via hepatic parenchymal transection-first approach.Methods:The clinical data of 16 patients with hepatocellular carcinoma who underwent laparoscopic anatomical central bisegmentectomy via hepatic parenchymal transection-first approach from Jan.2019 to Dec.2020 were reviewed and analyzed.The informed consents of all patients were obtained and local ethical committee approval had been received.Laparoscopic anatomical central bisegmentectomy via hepatic parenchymal transection-first approach were performed according to the preoperative imaging examinations and intraoperative exploration results,and the methods and surgical techniques of liver parenchyma transection-first were summarized.Results:Laparoscopic anatomical central bisegmentectomy via hepatic parenchymal transection-first approach was successfully performed in 16 patients without conversion to laparotomy.Average operation duration was(137.5±25.7)min,average blood loss was(130.3±47.4)mL,and no case needed intraoperative blood transfusion.Postoperative pleural effusion occurred in 1 case and bile leakage in 2 cases,they were cured after puncture and drainage.Postoperative pathology showed that 15 cases were hepatocellular carcinoma and 1 case was adenocarcinoma which was consistent with liver metastasis of colonic cancer,and the margins of the specimen were negative.Postoperative hospital stay was(6.8±2.7)d.There were no perioperative deaths.Conclusions:Laparoscopic anatomical central bisegmentectomy via hepatic parenchymal transection-first approach simplify the blood flow occlusion of extrathecal pedicle.It reduces the risk of intraoperative bleeding and important blood vessel and bile duct damage,and is more in line with the principle of"tumor-free".It is a simple,safe and effective technique with good clinical application prospect.