完全腹腔镜肝切除时出血问题的探讨

An inquiry into blood loss in laparoscopic liver resections

目的 探讨腹腔镜肝切除手术的出血原因和预防措施。 方法 2 1例中包括原发性肝癌 13例、肝血管瘤 3例、肝脓肿 2例、肝囊肿伴感染、局灶结节性增生、肝脏腺瘤各 1例。肝功能Child分级 :A级 16例 ,B级 5例 (均为肝癌病人 )。 结果 2 1例在全气腹条件下完成腹腔镜肝切除手术 ,包括肝局部切除 12例 ,左肝解剖性切除 9例。手术时间 80～ 32 0 (平均 193 8± 78 3)min ,出血量 10 0～ 10 0 0ml (平均 333 1± 2 91 4 )ml,有 2例出血 10 0 0ml,术中输血各 80 0ml。术后恢复顺利 ,术后平均住院时间 6 3± 1 5d ,术后恢复时间较常规开腹方法肝切除患者明显缩短。 结论 本组研究表明在现有的手术器械条件和不阻断肝门血流的情况下 ,可以安全方便地处理术中出血。腹腔镜肝切除微创手术的前景广阔 ,不仅适于对肝良性肿瘤的手术 。

Objective To investigate the potential causes and preventive measures for blood loss in laparoscopic liver resection. Methods The candidates for laparoscopic liver resections were 21 patients with liver lesions, including 13 patients with primary liver cancer,2 patients with liver abscess, 3 patients with liver hemangioma, 1 patient with hepatic cellular adenoma, 1 patient with hepatic focal nodular hyperplasia, and 1 patient with infected liver cyst. They were classified as Child A in 16 and B in 5 patients. Results Twenty one patients with liver lesions underwent 23 laparoscopic resections uneventfully. Operating procedures included partial liver resection in 12 patients, segment Ⅳ in 1 case and anatomical left liver resections in 8 patients. Operation duration was 80-320 (mean 193.8±78.3) minutes. The blood loss in operation was 100-1000 (mean 333.1±291.4) ml. The postoperative hospital stay averaged 6.3±1.5 days, which was markedly shortened in comparison to conventional laparotomy liver resections. In addition, there was no complication in this series. Conclusions Based on these preliminary results, occlusion of hepatic vessels with clamp is very important for partial liver resection. The key technique is to control the blood loss in operation. We conclude that laparoscopic liver resection is a prospective minimally invasive technique. These experiences suggest that laparoscopic procedures could be employed both in the treatment of benign and malignant tumors in selected cases.