摘要
目的探讨完全腹腔镜肝切除(Laparoscopic hepatectomy,LH)的手术技巧和临床效果。方法回顾性分析2005年5月至2008年3月对32例施行完全腹腔镜肝切除术病人手术时间、术中失血量、术后并发症等。其中,术后病理证实原发性肝癌(PLC)15例,肝血管瘤8例,大肠癌肝转移3例,左肝肝内胆管结石2例,肝脏局限性结节状增生1例,肝囊肿3例,上述肝脏占位病灶大小在3 cm×2 cm×2 cm～11 cm×8 cm×9 cm之间,标本装入塑料袋剪碎取出。结果本组32例手术在完全腹腔镜下完成,无中转开腹手术。手术时间55～263 min,平均168 min,术中出血量20～1000 ml,平均280 ml,2例术后发生胆漏,经充分引流2周治愈,1例合并糖尿病病人出院后1月出现肝断面感染,脓肿形成,经穿刺引流治愈,术后住院5～18天,平均9.2天。肝脏恶性肿瘤患者术后随访6个月至30个月(平均15个月),其中1例转移性肝癌术后6个月发生右侧腹壁戳孔种植转移。结论腹腔镜下肝切除术是一种安全、有效、微创的手术,但对恶性肿瘤,应注意种植转移。
Objective To summarize the surgical skills and clinical efficacy of total Laparoscopic hepatectomy（LH）.Methods Between May 2005 and March 2008,32 cases of LH were performed,the data including operating time,blood loss and postoperative complications,ect,were simultaneously analyzed retrospectively.Of all of the patients,the diseases performed LH including primary liver carcinoma（15 cases）,liver hemoangioma（8 cases）,colon carcinoma with liver metastasis（3 cases）,intrahepatic stone（2 cases） liver focar（1case） and liver cyst（3 cases）.Results The operation was successful in the 32 patients,mean blood loss was 280 ml,mean surgical time was 168 minutes,mean postoperative hospital day was 9.2（6～21） days.Postoperative complications including two cases of bile leakage,and one case of liver absess occur in one patient with diabetic.No other serious postoperative complications occurred.All the patients recovered successfully.The patients with malignant tumor were followed up for 6 to 30 months and there was no local recurrence,but one case of implantative metastases in trocar site ocurred in a patient with colon carcinoma with liver metastasis.Conclusions Laparoscopic hepatectomy a safe,effective and minimally invasive procedure for selected patients,but should preventing cancer cells to spread and plant.
出处
《肝胆外科杂志》
2010年第5期367-369,共3页
Journal of Hepatobiliary Surgery
关键词
腹腔镜
肝肿瘤
肝切除术
Laparoscopy
Liver tumor
Hepatectomy
