摘要
目的：探讨完全腹腔镜肝Ⅶ段肿瘤手术切除的可行性、安全性和手术技巧。方法回顾性分析2013年6月－2014年3月期间我院行完全腹腔镜下肝Ⅶ肿瘤切除10例患者的临床资料，其中原发性肝细胞癌8例、结肠癌肝转移1例、肝局灶性结节增生1例。术前均进行肝功能评估、CT三维血管成像确定肿瘤肝段位置及周围重要血管情况并进行手术规划，术中均采用超声刀、钛夹或Hem-o-lok 等断肝。结果10例患者均成功实施完全腹腔镜下肝Ⅶ段肿瘤切除术，手术时间105～215 min，失血量50～500 ml，术中未出现严重并发症，术后均康复出院，术后平均住院时间7．0 d。术后随访除1例原发性肝癌破裂患者术后约2月腹膜转移外，其余9例均未见复发。结论术前全面评估及手术规划、术中充分游离暴露肝脏肿瘤及腹腔镜下精准断肝技术是成功施行完全腹腔镜肝Ⅶ段切除术的重要保证。
Objective To investigate the feasibility and safety of total laparoscopic partial liver resection for tumor originated from segment Ⅶ and introduce the surgical technique.Methods From Jun. 2013 to Mar.2014,10 cases of laparoscopic partial liver resection for tumor originated from segment Ⅶ in our hospital were analyzed retrospectively,including 8 cases of hepatocellular carcinoma,1 case of liver metastasis from colon cancer and 1 case of focal nodular hyperplasia.Child Classification and ICG R15 were used to evaluate hepatic reservation function preoperatively and three-dimensional CT imaging was used to assess the anatomical structure surrounding liver tumor such as blood vessels,intraoperative surgical approach is selected according to the liver lesion site and using ultrasonic knives,clips,Hem-o-lok and other laparoscopic equipments to dissect liver and complete partial liver resection.Results Total laparoscopic partial liver resection was carried successfully on 10 cases,with operative time between 105 to 215 minutes, blood loss between 50 to 500 ml. All patients recovered from the operation successfully with no complications.The average hospital stay postoperation was 7.0 d.Except one case of primary liver cancer with tumor rupture before operation were found to have peritonaeum metastasis about 2 months follow-up after operation,the rest has been found no evidence of tumor recurrence as yet.Conclusion Preoperative assessment of liver function and CT imaging,intraoperative adequate dissection and skilled application of the laparoscopic precise hepatectomy are the essential for successful and safe completion of laparoscopic partial liver resection for tumor originated from segment Ⅶ.
出处
《中华腔镜外科杂志（电子版）》
2014年第5期9-12,共4页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
基金
江苏省"科教兴卫工程"医学领军人才和创新团队项目(LJ201134)
江苏省"青蓝工程"创新团队培养对象项目(苏教师[2010]27号)
江苏省临床医学科技专项基金资助项目(SBL2014020017)
关键词
腹腔镜
肝Ⅶ段
肿瘤切除术
Laparoscopic Segment Ⅶ Liver tumor resection
