腹腔镜解剖性肝切除治疗位于中央部位肝癌单中心经验

doi:10.3877/cma.j.issn.1674-6899.2021.01.005

目的

探讨腹腔镜解剖性肝切除治疗中央部位肝细胞癌的安全性和可行性。

方法

2015年1月至2019年12月，12例肿瘤位于肝中央部位的肝细胞癌患者在佛山市第一人民医院肝脏外科实施了腹腔镜肝切除；其中男9例、女3例，平均年龄(55.5±6.8)岁，平均肿瘤直径(3.7±2.5)cm，术前肝脏储备功能ICG-R15(3.9±2.82)%，肝功能Child-Pugh分级A级。实施肝Ⅳ～Ⅷ段切除5例、肝Ⅴ～Ⅷ段切除6例、肝Ⅳ段切除1例。统计分析手术时间、手术切缘、术中出血量、术后并发症及住院时间等。

结果

12例患者均在腹腔镜下完成手术，无中转开腹，平均手术时间(398.8±115.4)min，平均术中出血量(420.8±279.2)ml，有1例输血，术后平均住院时间(9.1±2.2)d，无围手术期死亡病例，术后并发症包括肝断面出血1例、胆漏1例、膈下包裹性积液1例，平均手术切缘(1.2±0.6)cm。

结论

对位于肝中央部位的肝细胞癌，行解剖性肝Ⅳ～Ⅷ段切除、肝Ⅴ～Ⅷ段切除以及肝Ⅳ段切除是安全、可行的。采取肝内Glissonian鞘外的方法预先控制肝蒂有利于掌握断肝平面，术前精准的评估，术中有效的控制出血以及娴熟的腔镜外科技术能有效帮助术者安全实施手术。

关键词: 腹腔镜, 解剖性肝切除, 中央部位肿瘤, 肝细胞癌

Objective

To investigate the safety and feasibility of laparoscopic anatomical liver resection in the treatment of central hepatocellular carcinoma.

Methods

To retrospectively analyze 12 patients with central liver tumors treated with laparoscopic anatomical liver resection from Jan. 2015 to Dec. 2019 in Department of Liver Surgery, The First People′s Hospital of Foshan.There were 9 males and 3 female with average age (55.5±6.8) years , whose preoperative liver reserve function ICG-R15 was (3.9±2.82)%. The Child-Pugh score of the patients′ liver function all were grade A. The mean diameter of hepatic lesions was(3.7±2.5) cm.We performed 5 cases liver segment Ⅳ-Ⅷ resection, 6 cases liver segment Ⅴ-Ⅷ resection and 1 case liver segment Ⅳ resection.The patients′ information about operation time, resection margin, blood loss, postoperative complications and postoperative hospital stay were collected.

Results

All 12 cases were successfully completed, No one was converted to laparotomy, The operation time was (398.8±115.4) minutes.The intraoperative blood loss was (420.8±279.2) ml and one case needed blood transfusion.The average surgical margin was (1.2±0.6) cm.The mean postoperative hospital stay was (9.1±2.2)days and no perioperative death happened.Postoperative complications included 1 bleeding from liver section, 1 bile leakage, 1 subphrenic encapsulated effusion.

Conclusions

For hepatocellular carcinoma located in the central part of the liver, it is safe and feasible to perform anatomical liver segment Ⅳ-Ⅷ resection, segment Ⅴ-Ⅷ resection and segment Ⅳ resection.Pre-controlling the liver pedicle by the intrahepatic Glissonian extrathecal method is beneficial to master the plane of the liver division.With accurate preoperative assessment, effectively control intraoperative bleeding, skilled endoscopic surgical techniques, we can perform this challenging operation safely.

Key words: Laparoscopy, Anatomical liver resection, Central liver tumors, Hepatocellular carcinoma

图1 显示全腹腔镜肝Ⅴ、Ⅷ段切除主要手术步骤

图2 显示全腹腔镜肝Ⅳ、Ⅴ、Ⅷ段切除的主要手术步骤

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Laparoscopic anatomical liver resection for the treatment of centrally located hepatocellular carcinoma: a single-center experience

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Laparoscopic anatomical liver resection for the treatment of centrally located hepatocellular carcinoma: a single-center experience