摘要
目的:总结腹腔镜肝切除术治疗肝脏良恶性疾病的手术经验,探讨腹腔镜肝切除术的技术要点与临床疗效。方法:回顾分析2015年3月至2018年6月为62例肝脏肿瘤患者行腹腔镜肝切除术的病例资料。结果:62例患者中59例成功施行全腹腔镜肝切除术,3例中转开腹。28例行腹腔镜下解剖性肝切除术,34例行非解剖性肝切除术。手术时间平均(164.1±67.9) min,术中出血量150(100,200) mL。无手术死亡病例,术后平均住院(6.5±2.1) d,术后病理诊断为肝细胞性肝癌15例,肝海绵状血管瘤33例,结肠癌肝转移1例,肝细胞腺瘤1例,肝内多发结石12例;术中冰冻回报切缘均为阴性。复发3例,死亡2例,复发者均为行腹腔镜右半肝切除术的患者。结论:腹腔镜肝切除术治疗肝脏良恶性疾病是安全、可靠的,具有创伤小、康复快等优势,关键在于严格掌握手术适应证,有效预防、控制术中肝出血,合理选择肝实质离断平面,妥善安全地处理肝断面。腹腔镜肝切除术的普及、推广需要依靠具有丰富经验的培训体系与团队,腹腔镜肝切除术会更加普及。
Objective:To summarize the operative experience of laparoscopic hepatectomy for benign and malignant liver diseases,and to explore the technical points and curative effects of laparoscopic hepatectomy.Methods:Retrospective analysis was made on the clinical data of 62 patients who suffered from liver cancer and underwent laparoscopic hepatectomy from Mar.2015 to Jun.2018.Results:Of the 62 patients,59 underwent total laparoscopic hepatectomy and 3 converted to laparotomy.There were 28 cases of laparoscopic anatomical liver resection and 34 cases of non-anatomical liver resection.The operation time was(164.1±67.9)min,the median intraoperative blood loss was 150(100,200)mL.No operative death occurred.All patients were safely discharged from the hospital after operation.The postoperative hospital stay was(6.5±2.1)d.The results of postoperative pathology were 15 cases of hepatocellular carcinoma,33 cases of hepatic cavernous hemangioma,1 case of hepatic metastasis of colon cancer,1 case of hepatocellular adenoma and 12 cases of multiple hepatolithiasis in the liver,all resection margins were negative in intraoperative frozen section.There were 3 cases of recurrence,2 cases of death,and all patients with recurrence had undergone laparoscopic right hemihepatectomy.Conclusions:Laparoscopic hepatectomy is safe and reliable for the treatment of benign and malignant liver diseases.It has advantages of few trauma and quick recovery.The key to laparoscopic hepatectomy is to grasp the surgical indications strictly,effectively prevent and control the intraoperative liver hemorrhage,select the plane of liver parenchyma dissection,properly and safely handle the liver section.The popularization and promotion of laparoscopic hepatectomy should depend on the experienced training system and team,and laparoscopic hepatectomy will become more popular in the future.
作者
霍天宇
甘莉
朱洪银
崔王平
魏志刚
HUO Tian-yu;GAN Li;ZHU Hong-yin(Shanxi Medical University,Taiyuan 030000,China)
出处
《腹腔镜外科杂志》
2018年第12期885-890,共6页
Journal of Laparoscopic Surgery
基金
山西省国际科技合作项目(编号:2015081039)
