完全腹腔镜肝尾状叶肿瘤切除术13例疗效分析

Totally laparoscopic resection of hepatic caudate lobe tumors:curative effect analysis of 13 cases

目的:探讨腹腔镜肝尾状叶肿瘤切除术的安全性及临床疗效。方法:收集2013年1月至2022年6月行腹腔镜肝尾状叶肿瘤切除术的13例患者的临床资料。统计分析术前、术中及术后相关资料,包括基本资料、手术时间、术中出血量、术后并发症、术后住院时间及术后病理情况。结果:13例患者中2例在3D腹腔镜下完成。经病理证实原发性肝癌9例、局灶性结节性增生1例、海绵状血管瘤3例。8例行腹腔镜单独肝尾状叶肿瘤切除术,2例行腹腔镜肝尾状叶肿瘤切除联合胆囊切除术,3例行腹腔镜肝尾状叶肿瘤切除联合肝左外叶切除术。11例采用左侧入路,2例采用右侧入路。手术时间平均(170.8±89.3)min,术中失血量(181.8±50.5)mL,术后平均住院(7.6±0.7)d。术中行第一肝门阻断12例,4例患者术中予以输血。术后发生1例胆漏,并发症发生率为7.7%,无围手术期死亡及二次手术病例。患者切缘均为阴性,肿瘤直径平均(4.5±2.1)cm。术后随访3~24个月,2例患者发生肝内转移复发。结论:在术前掌握手术适应证、术中充分显露及良好血流控制的前提下,腹腔镜肝尾状叶切除术是安全、有效的,可获得满意效果。

Objective:To investigate the safety and clinical efficacy of laparoscopic resection of liver caudate lobe tumors.Methods:The clinical data of 13 patients who underwent laparoscopic resection of caudate lobe tumor from Jan.2013 to Jun.2022 were collected.The preoperative,intraoperative and postoperative data were statistically analyzed,including basic data,operation time,intraoperative blood loss,postoperative complications,postoperative hospital stay and postoperative pathology.Results:Two of the 13 patients were performed 3D laparoscopy.Pathologically,there were 9 cases of primary liver cancer,1 case of focal nodular hyperplasia and 3 cases of cavernous hemangioma.8 patients received laparoscopic resection of caudate lobe tumor alone,2 patients received laparoscopic resection of caudate lobe tumor combined with cholecystectomy,and 3 patients received laparoscopic resection of caudate lobe tumor combined with left lateral hepatic lobectomy.The left approach was used in 11 patients and the right approach was used in 2 patients.The mean operation time was(170.8±89.3)min,intraoperative blood loss was(181.8±50.5)mL,and the mean postoperative hospital stay was(7.6±0.7)d.The first porta hepatis was clamped in 12 cases and blood transfusion was given in 4 cases.One case of bile leakage occurred after operation,and the complication incidence was 7.7%.No perioperative death and reoperation occurred.The resection margin of all patients was negative,and the average tumor diameter was(4.5±2.1)cm.During the follow-up of 3 to 24 months,intrahepatic metastasis and recurrence occurred in 2 patients.Conclusions:On the premise of preoperative control of indications,introperative full exposure and good blood flow control,laparoscopic caudate lobectomy is safe and feasible with satisfactory results.