完全性腹腔镜肝切除术57例临床分析.docVIP

省医院林编辑推荐330211832@ 完全性腹腔镜肝切除术57例临床分析 张浩 董科 温尔刚 俞小炯 四川省医学科学院·四川省人民医院 肝胆外二科 【摘要】 目的 总结完全性腹腔镜肝切除术的技术要点和手术效果。 方法 回顾我院2009年8月-2012年7月，共57例完全性腹腔镜下肝切除患者的临床资料。 结果 57例患者中转开腹1例，其余顺利完成完全腹腔镜下肝切除术。规则性肝叶(段)切除25例，其中左半肝切除6例，左外叶切除16例，Ⅵ段切除2例，Ⅶ段1例（后中转开腹）；不规则肝部分切除32例。平均手术时间为195.23±81.28min，平均出血量275.70 ±202.57 m1，平均住院时间9 ±2.31d，全组术后有1例并发胆漏，无手术死亡病例发生。术后平均随访2～20个月，1例肝癌患者术后第13月局部复发，其余恶性肿瘤患者无复发，良性病变患者无症状再发。 结论 腹腔镜肝切除术是一种安全有效的微创手术方式，需要有丰富的临床和腔镜经验的肝胆外科医生，有选择性的针对适宜的肝脏疾患病人施行，手术要点就是控制术中出血和空气栓塞，以及妥善的处理肝断面，从而确保手术成功和减少手术并发症的发生。 【关键词】腹腔镜；肝切除术 Clinic anaysis of total laparoscopic liver resections:w ith experiences of 57 case Zhang hao,Dong ke,Wen Er-gang,et al. （2nd Department of Hepatobiliary Surgery, the Sichuan Academy of Medical Sciences ＆Sichuan Provincial People’s Hospital,Chengdu 610072,China） 【Abstract】Objective To review techniques and outcome of laparoscopic 1iver resection． Methods A retrospective analysis was done based on the clinical data of 57 patients undergone totally laparoscopic liver resection from August 2009 to July 2012． Results All of the patients but 1 converted to laparotomy were received total laparoscopic 1iver resection． Anatomical liver resection was carried out on 25 patients including 6 with left hemihepatectomy，16 with 1eft lateral segmentectomy，and 2 with segment VI resection,1 with segment Ⅶ(converted to laparotomy)；32 patients underwent nonanatomical hepatectomy．The average operation time was 195.23±81.28 minutes，average blood loss 275.70 ±202.57 m1，and average hospital stay 9 ±2.31 days．There were no postoperative complications occurred except 1 with bile leakage. No operative death occurred． All the patients were followed up for 2-20 months，no recurrence was found in patients with benign or malignant liver tumor except 1 with hepatocellular carcinoma recurred 13 months after operation．Conclusions The laparoscopic liver resection is feasible and safe if this new approach can be proposed by a surgeon experienced in laparoscopic and hepatic surgery. The key