腹腔镜肝切除术的手术入路探讨

Operational line of laparoscopic liver resections

目的 介绍完全腹腔镜下肝切除手术的入路 ,以期进一步提高腹腔镜肝切除的水平。方法 在不阻断全肝血流的情况下 ,应用多种器械于完全腹腔镜下进行肝切除 2 7例 ,其中原发性肝癌 14例、肝囊肿伴感染 1例、肝门部胆管癌 1例、肝脏血管瘤 6例、肝脏局灶结节性增生 1例、炎性肉芽肿 1例、肝脏腺瘤 1例、肝脓肿 2例。结果 2 7例手术均在完全腹腔镜下顺利完成 ,平均手术时间184min ,平均出血量 4 4 1ml。术后平均住院 5d ,腹腔引流管放置时间 2～ 4d。未发生胆漏、出血、感染等并发症。结论 选择合适的腹腔镜下手术入路对于手术的成功具有重要作用。利用现有的手术器械条件及在不阻断全肝血流的情况下 ,腹腔镜肝切除是安全可行的。该方法是病灶局限于左半肝及部分右肝病例的首选术式之一。

Objective To evaluate the feasibility and indications of laparoscopic liver resections. Methods Twenty-seven patients with liver lesions, 17 men and 10 women, aged 31～67, including 14 cases of primary liver cancer,6 cases of liver hemangioma, 2 cases of liver abscess,1 case of hilar carcinoma,1 case of hepatic adenoma,1 case of hepatic focal nodular hyperplasia, 1 case of liver inflammatory granuloma, and 1 case of infected liver cyst, underwent laparoscopic liver resection, partial liver resection in 17 cases and anatomical left liver resections in 10 cases, consecutively from July 2002 to April 2003. The clinical data were analyzed. Results All of the 27 operations were performed smoothly with an average operation time of 184 min and the average blood loss during operation of 441 ml. The average postoperative hospital stay was 5 days. No complication occurred. Conclusion A promising minimally invasive technique, laparoscopic liver resection can be carried out safely and effectively by experienced surgeons as one of the first choices for the loci limited to left liver and part of the loci in right liver.