无血流阻断全腹腔镜下解剖性肝切除术的临床应用体会

doi:10.3877/cma.j.issn.1674-6899.2016.05.010

目的

探讨无血流阻断全腹腔镜下解剖性肝切除术的临床应用价值。

方法

回顾性分析解放军海军安庆医院2015年6月至2016年3月期间实施无血流阻断全腹腔镜下解剖性肝切除术的12例患者的临床资料，其中左肝内胆管结石9例，肝癌2例，肝血管瘤1例。

结果

12例患者的手术均获成功，其中左肝外叶切除2例(Ⅱ ＋ Ⅲ段)，左半肝切除10例(Ⅱ ＋ Ⅲ ＋ Ⅳ段9例、Ⅴ ＋ Ⅶ ＋ Ⅷ段1例)；手术时间(210.75 ± 65.83)min，术中出血量(296.67 ± 373.74)ml，术后肛门首次排气时间(2.71 ± 0.84)d，术后住院时间(13.92 ± 5.98)d，住院费用(32 004.19 ± 8 630.79)元。术后并发症发生3例，其中术后胃瘫1例、胆漏1例、肺部感染1例。所有患者术后随访3～15个月，其中2例肿瘤患者未复发或转移，肝内胆管结石未见结石残留及复发。

结论

无血流阻断全腹腔镜下解剖性肝切除术是安全有效的，是未来肝脏微创外科发展的方向之一。

关键词: 腹腔镜, 肝脏, 肝切除术, 无血流阻断

Objective

To investigate the value of completely laparoscopic anatomical liver resection without bleeding control.

Methods

We retrospectively analyzed the clinical data of 12 cases of completely laparoscopic anatomical liver resection without bleeding control in our hospital from Jun. 2015 to Mar. 2016.Twelve patients included left intrahepatic bile duct calculi (9 cases) , liver cancer (2 cases), liver hemangioma (1 case).

Results

The surgery of 12 cases was successfully completed. Completely laparoscopic anatomical liver resection included left the outside leaf resection (Ⅱ + Ⅲ section) in 2 cases, left half liver excision (Ⅱ + Ⅲ + Ⅳ section) 9 cases, Ⅴ + Ⅶ + Ⅷ section in 1 case. The mean operative time was (210.75 ± 65.83)min, blood losses were (296.67 ± 373.74)ml, Postoperative exhaust time was (2.71 ± 0.84)d, hospitalization after surgery was (13.92 ± 5.98)d, treatment costs for the operative were (32 004.19 ± 8 630.79)yuan. Surgery complications occurred in 3 cases, 1case was gastroparesis, 1 case was bile leakage and 1 case was pulmonary infection. In follow-up between 3 to 15 months, 2 cases of tumor patients were no recurrence or metastasis, none cases of stone patients were stone residue and recurrence.

Conclusions

Completely laparoscopic anatomical liver resection without bleeding control is safe and effective, is one of the future development of minimally invasive surgery of liver.

Key words: laparoscopic, Liver, Liver resection, No bleeding control

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Clinical application experience of completely laparoscopic anatomical liver resection without bleeding control

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Clinical application experience of completely laparoscopic anatomical liver resection without bleeding control