腹腔镜下规则性肝切除11例分析

LAPAROSCOPIC ANATOMICAL LIVER RESECTIONS

目的 介绍完全腹腔镜下规则性肝切除。方法 在不阻断全肝血流的情况下 ,应用多种器械在腹腔镜下进行规则性肝切除 11例 ,其中原发性肝癌 4例、肝囊肿伴感染 1例、肝门部胆管癌 1例、肝脏炎性假瘤 1例、肝脏血管瘤 4例。结果 11例手术均完全在腹腔镜下顺利完成 ,左半肝切除 3例、左外叶切除 6例、肝方叶切除 1例、右后叶下段切除 1例。左肝各段(2、3、4段 )均有独立的 3级肝门结构 ,均可在矢状部对 2至 3级肝门的三管进行解剖和离断。平均手术时间 2 15 .2 m in,平均出血量 5 33.3m l。术后平均住院 5 .1d,腹腔引流管放置时间 2～ 4 d。未发生胆漏、出血、感染等并发症。结论 本组初步临床经验表明 ,在现有的手术器械条件及在不阻断全肝血流的情况下 ,可以较安全地进行腹腔镜下规则性肝切除。该方法可作为局限于左半肝病例的首选术式之一。

Objective To evaluate the feasibility and indications of laparoscopic anatomical liver resections.Methods The candidates for laparoscopic anatomical liver resections were 11 cases with liver lesions including 4 cases of primary liver cancer,1 case of infected liver cyst,4 cases of liver hemangioma,1 case of hilar carcinoma.Result Surgical procedures included left hepatectomy in 3 cases,left lobectomy in 6 cases,segment 6 in 1 case and segment 4 resection in 1 case.Operation time averaged 215.2min.The blood loss in operation averaged 533.3ml.The postoperative hospital stay averaged 5.1 days.There was not complication.Conclusions Based on these preliminary results,we conclude that laparoscopic liver resection is a prospective minimally invasive technique,which can be carried out safely and effectivelyby experienced laparoscopic skill in anatomical dissection.The authors'experience suggests that laparoscopic procedures could be reserved for both benign and malignant tumors in selected cases.