腹腔镜肝切除12例临床报告.docVIP

腹腔镜肝切除12例临床报告 李平军,杨峻峰,胡伟,袁爱军,嵇振岭,杨德同 南通瑞慈医院、扬州大学第四临床医学院 中德微创外科合作中心，江苏 南通，226010 李平军,杨峻峰,胡伟,袁爱军,嵇振岭 东南大学附属中大医院普外科 杨德同 [摘要]目的 探讨腹腔镜下肝切除手术的临床应用价值。方法 经筛选病灶均位于肝边缘或肝表面，其中原发性肝癌5例，肝血管瘤4例，肝局灶结节增生2例，肝左外叶结石并纤维化1例。肝功能Child分级A级11例,B级1例。应用超声刀、多功能手术解剖器断肝，采用钛夹夹闭、氩气刀凝血、医用生物蛋白胶粘封处理肝断面。结果 全部病例均在全气腹条件下完成腹腔镜肝部分切除术，手术时间平均123min，出血量平均320ml，有一例出血800ml ,腹腔引流管放置时间2至5天，术后无胆漏和出血等并发症，术后平均住院时间8.2天。结论 位于肝边缘、肝表面的体积较小的肝肿瘤病人行腹腔肝切除术是安全可行的。 [关键词] 腹腔镜；肝切除；超声刀；多功能手术解剖器 Laparoscopic Hepatectomy in 12 patients LI Pingjun,YANG Junfeng,HU Wei,et al.Center For Minimally Invasive Surgery With The Cooperation of Marien Hospital Stuttagart Germany and Rich Hospital Nantong China, College of Medicine, Yangzhou University,Nantong 226010,China [Abstract] Objective To evaluate the technique of Laparoscopic Hepatectomy. Methods The hepatic neoplasms were located on the surface or the edge of the liver, including: liver cancer 5 cases, hemangioma 4 cases, focal nodal hyperplasia 2cases. Calculi with fibrosis on the left lateral lobe of the liver was 1case. Child degree of liver function: 11 case in A degree, 1 case in B degree. Ultrasonic dissector and Pengs multifunctional operative dissector PMOD were applied to divide the liver parenchyma. We managed the law surface of the liver by using titaum clip, argon beam coagulator and glue. Results All of these cases were successfully received laparoscopic Hepatectomy under artificial pneumoperitoneum. Mean operative time was 123 minutes, mean blood loss was 320 ml. One case had lost 800 ml blood during the operation. Abdominal drainage placed for 2 to 5 days. No complication of bile leakage or hemorrhage happened. Mean admission time was 8.2 days. Conclusion it’s safe and practicable to the patients of hepatic occupying lesion that located on the edge or surface of the liver received laparoscopic Hepatectomy. [Key words] laparoscopic Hepatectomy ultrasonic dissector PMOD 1987年mouret成功施行腹腔镜胆囊切除术以来，随着技术的逐渐成熟和经验的不断积累，腹腔镜外科的适应范围在进一步扩大。由于肝脏是人体的储血器官，有肝动脉、门静脉双重供血，加