术前模拟切除在腹腔镜解剖性肝切除术中的应用

Preoperative simulative resection in laparoscopic anatomical hepatectomy

目的探讨术前模拟切除技术在腹腔镜解剖性肝切除术中的应用价值。方法采用回顾性横断面研究方法,选取2020年9月至2022年1月因肝细胞性肝癌接受术前行模拟切除后实施腹腔镜肝叶、肝段、亚肝段或联合切除病例22例。观察分析手术时间、术中出血量、术后住院时间及术后并发症信息。结果 22例患者均在术前进行了模拟切除的规划,部分患者因术前规划改变原定手术方式,所有患者手术顺利,无中转开腹。中位手术时间170.0 min,中位术中出血量150.0 ml,中位阻断次数4次,中位术后住院时间6.5 d,所有病例均无严重术后并发症发生。结论术前模拟切除能精确规划出手术切除范围,显示重要的解剖结构,能够提高手术效率、保证足够的手术切缘。

Objective To formulate surgical strategies and guide the implementation of laparoscopic anatomical hepatectomy with preoperative simulative resection.Methods Twenty-two cases of hepatocellular carcinoma undergoing laparoscopic lobe,segment,subsegment and combined segment liver resection following preoperative simulative resection from Sep 2020 to Jan 2022 were enrolled in this study retrospectively.We observed and analyzed the operation time,intraoperative blood loss,postoperative hospital stay and postoperative complication.Results All patients underwent laparoscopic hepatectomy successfully according to the preoperative simulative resection plan without conversion,some of them adjusted plan according to preoperative simulative resection.The median operation time was 170.0 min,the median intraoperative blood loss was 150.0 ml,the median times of pringle maneuver was done on 4 episodes,and the median postoperative hospital stay was 6.5 days.There were no severe postoperative complications in all cases.Conclusion Preoperative simulative resection can plan the range of surgical resection accurately by visualizing important anatomical structures,greatly helping the actual surgical hepatectomy.