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中华腔镜外科杂志(电子版) ›› 2025, Vol. 18 ›› Issue (06) : 374 -378. doi: 10.3877/cma.j.issn.1674-6899.2025.06.009

临床技术

Laennec入路联合背侧入路腹腔镜手术治疗肝纤维板层癌
陈超波1,2, 蔡凤军1, 陈胜诺1, 赵春龙1, 佟根喜1, 余德才2,()   
  1. 1214105 江苏省无锡市锡山人民医院普外科
    2210008 南京大学医学院附属鼓楼医院肝胆与肝移植外科
  • 收稿日期:2025-08-04 出版日期:2025-12-30
  • 通信作者: 余德才
  • 基金资助:
    国家自然科学基金(82372834, 82173129); 南京鼓楼医院临床研究专项资金面上项目(2021-LCYJMS-12); 无锡市卫生健康委中青年拔尖人才资助计划(HB2023116)

Laennec approach combined with dorsal approach for laparoscopic treatment of fibrolamellar hepatocellular carcinoma

Chaobo Chen1,2, Fengjun Cai1, Shengnuo Chen1, Chunlong Zhao1, Genxi Tong1, Decai Yu2,()   

  1. 1Department of General Surgery, Xishan People′s Hospital of Wuxi City, 214105, China
    2Department of Hepatobiliary and Liver Transplantation Surgery, Drum Tower Hospital Affiliated to Nanjing University School of Medicine, 210008, China
  • Received:2025-08-04 Published:2025-12-30
  • Corresponding author: Decai Yu
引用本文:

陈超波, 蔡凤军, 陈胜诺, 赵春龙, 佟根喜, 余德才. Laennec入路联合背侧入路腹腔镜手术治疗肝纤维板层癌[J/OL]. 中华腔镜外科杂志(电子版), 2025, 18(06): 374-378.

Chaobo Chen, Fengjun Cai, Shengnuo Chen, Chunlong Zhao, Genxi Tong, Decai Yu. Laennec approach combined with dorsal approach for laparoscopic treatment of fibrolamellar hepatocellular carcinoma[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(06): 374-378.

目的

通过回顾本中心原发性肝纤维板层癌的患儿腹腔镜手术的诊疗过程,总结并讨论Laennec入路联合背侧入路治疗肝纤维板层癌的微创技术经验。

方法

2025年3月无锡市锡山人民医院肝胆外科收治的1例12岁肝占位患儿,临床诊断为肝纤维板层癌,通过术前充分评估,制定腹腔镜手术治疗策略。

结果

患者顺利接受Laennec入路腹腔镜下鞘内解剖联合背侧入路行左半肝切除+肝门淋巴结清扫+胆囊切除术,术中出血少,术后无感染、出血、胆漏、门静脉血栓等并发症,恢复顺利,术后病理结果为肝纤维板层癌。

结论

手术是治疗肝纤维板层癌唯一有效策略,肿瘤紧邻肝门矢状部的情况,在经过系统、全面的术前评估后,可以采用Laennec入路鞘内解剖联合背侧入路进行腹腔镜肝切除,保证手术切缘并减少出血,提高手术安全性,使患者获益。

Objective

By reviewing the diagnosis and treatment process of a pediatric patient with primary fibrolamellar hepatocellular carcinoma (FLC) who underwent laparoscopic surgery at our center, we summarize and discuss the technical experience of combining Laennec approach with dorsal approach in minimally invasive management of FLC.

Methods

Based on a 12-year-old pediatric patient with a hepatic space-occupying lesion admitted to the Department of Hepatobiliary Surgery at Wuxi Xishan People′s Hospital in Mar. 2025, who was clinically diagnosed with FLC, a laparoscopic surgical strategy was formulated after thorough preoperative evaluation.

Results

The patient successfully underwent laparoscopic left hemihepatectomy via the Laennec approach (intracapsular dissection) combined with a dorsal approach, along with hilar lymph node dissection and cholecystectomy. The procedure was associated with minimal intraoperative blood loss. Postoperatively, there were no complications such as infection, hemorrhage, bile leakage, or portal vein thrombosis. The patient recovered smoothly. Pathological examination confirmed the diagnosis of FLC.

Conclusion

Surgery remains the only effective strategy for treating FLC. For tumors adjacent to the sagittal portion of the hepatic hilum, a laparoscopic hepatectomy utilizing the Laennec approach (intracapsular dissection) combined with a dorsal approach could be adopted after systematic and comprehensive preoperative evaluation. This strategy ensures adequate surgical margins, reduces intraoperative bleeding, enhances procedural safety, and ultimately benefits the patient.

图1 腹部增强CT注:A.平扫可见肝左内叶团块低密度灶;B.动脉早期见肿瘤不均质强化,中央放射状低密度影;可见左肝管癌栓(红色圈);C.门静脉期见肿瘤强化减退,中央区放射状低密度影;D.门静脉延迟期肿瘤呈轻度强化,中央区放射状低密度影
图2 Laennec入路联合背侧入路左半肝切除关键点和面注:A.鞘内解剖显露肝左动脉;B.鞘内解剖、Laennec入路显露门静脉左侧支;C.鞘内解剖、Laennec入路显露左肝管癌栓,离断并切缘快速病理检测;D.尾状叶指引、Laennec入路显露肝中静脉根部,确认背侧入路肝实质离断平面;E.S4a段肝蒂显露确认腹侧肝实质平面;F.腹侧、背侧入路汇合,显露肝实质离断平面,Laennec入路显露肝左静脉根部汇入点
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