摘要
目的 探讨腹腔镜肝切除手术的解剖基础与技术问题。 方法 选择病灶位于肝脏边缘、右肝表面或左半肝且肝功能Child分级B级以上 1 6例 ,其中原发性肝癌 8例 ,肝血管瘤 3例 ,左肝管胆管癌、肝细胞腺瘤、局灶性结节性增生、肝脓肿和肝囊肿伴感染各 1例。在上腹部放置 4～ 6个Trocar,应用电刀、超声刀和腔内直线形切割钉合器等多种断肝方法 ,采用钛夹夹闭、医用生物蛋白胶粘封等处理肝断面。 结果 对 1 6例在全气腹条件下完成 1 8个病灶的腹腔镜肝切除手术 ,包括左肝规则性切除 8例 ,肝局部切除 8例。手术时间 (2 0 6± 75 )min ,出血量 (35 4± 2 82 )ml,2例出血 1 0 0 0ml,术中输血 80 0ml。腹腔引流管放置时间 2天～ 4天 ,术后未发生胆漏和出血等并发症 ,术后住院 (5 8± 1 6 )天。 结论 腹腔镜肝切除手术的关键是恰当处理要切除肝的蒂部脉管 。
Objective To evaluate the anatomical basis and techniques in laparoscopic liver resections. Methods Entered the study there were 16 patients with both their lesions located at liver margin, or the surface of the right liver, or left liver and their liver functions classified as Child B or above, including 8 cases of primary liver cancer, 3 cases of liver hemangioma, 1 case of cholangiocarcinama, 1 case of hepatic adenoma, 1 case of focal nodular hyperplasia, 1 case of liver abscess and 1 case of infected liver cyst. The procedures were performed, via 4～6 epigastric ports, by using electriccautery, ultracision or endo-cutter for transecting liver and by titanic clip or medical albumin glue for dealing with the cut surface. Results Laparoscopic liver resection was completed under pneumoperitoneum in 16 cases (18 lesions), including 8 cases of local liver resection and 8 cases of anatomical left liver resection. The operation time was (206±75) min and the blood loss was (354±282) ml. An intraoperative blood transfusion of 800 ml was required in 2 cases because of a blood loss of 1000 ml. The abdominal drains were left for (2～4) days and no bile leakage, bleeding or other complications happened. The postoperative hospital stay was (5.8±1.6) days. Conclusions Proper dealing with hepatic portal vessels is the key to the laparoscopic liver resection. In order to effectively control the bleeding during the partial hepatectomy or left hemihepatectomy, it is crucial to fully dissect the sub-grade hepatic portal vessels.
出处
《中国微创外科杂志》
CSCD
2003年第6期473-475,共3页
Chinese Journal of Minimally Invasive Surgery
