摘要
目的探讨完全腹腔镜解剖性肝Ⅷ段切除的策略、安全性及近期疗效。方法回顾分析湖南省人民医院2015年1月至2019年12月行腹腔镜解剖性肝Ⅷ段切除9例患者资料,其中男性6例,女性3例,年龄范围29~67岁,平均年龄53.6岁。观察手术时间、术中失血量、术后住院时间、术后并发症等指标。出院后随访生存和复发情况。结果9例患者均在腹腔镜下完成解剖性肝Ⅷ段切除。手术时间140~240 min,平均188.9 min。术中失血量20~300 ml,平均117.8 ml。1例术后出现胸腔积液,保守治疗治愈;1例出现腹水,延迟拔管治愈。9例患者均无Clavien-DindoⅢa级以上并发症。无围手术期死亡。术后住院时间3~12 d,平均6.9 d。术后病理结果:肝细胞腺瘤2例、肝细胞癌4例、胆管细胞癌1例、转移性肝癌2例。9例患者均获随访,随访12~58个月,中位随访时间22个月。1例原发性肝癌患者术后18个月复查发现肝内复发,行微波消融治疗,其余未见明显复发征象。结论在充分术前评估、合理病例选择、严谨手术规划、娴熟腹腔镜操作技术的前提下,腹腔镜肝Ⅷ段切除安全可行,近期疗效优良。
Objective To study the feasibility,safety and technique for laparoscopic anatomical liver resection of segment 8.Methods The clinical data of 9 patients who underwent laparoscopic anatomical liver resection of segment 8 from January 2015 to December 2019 at Hunan Provincial People's Hospital were retrospectively analyzed.There were 6 males and 3 females,with age ranging from 29 to 67 years(average 53.6 years).The operation time,intraoperative blood loss,postoperative hospital stay,postoperative complications,and long-term survival and recurrence rates on follow-up were analysed.Results Laparoscopic anatomical liver resection of segment 8 was successfully carried out in these patients.The mean operative time was 188.9 min(range 140-240 min).The mean estimated intraoperative blood loss was 117.8 ml(range 20-300 ml).The postoperative hospital stay was 6.9 days(range 3-12 days).One patient developed pleural effusion after operation and responded to conservative treatment.Another patients developed ascites with delayed extubation.The patient was successfully treated with conservative treatment.No patients developed complications above Clavien DindoⅢa.There were no perioperative deaths.The postoperative pathological results showed hepatocellular adenoma(n=2),hepatocellular carcinoma(n=4),cholangiocarcinoma(n=1),and metastatic liver cancer(n=2).On follow-up for 12-58 months(median 22 months)one patient with hepatocellular carcinoma developed recurrence at 18 months after operation and was treated with microwave ablation.The other patients were well on follow-up.Conclusions With adequate preoperative evaluation,reasonable case selection,rigorous surgical planning,and skilled laparoscopic techniques,laparoscopic anatomical liver resection of segment 8 was safe and feasible,and the short-term efficacy was good in this study.
作者
谭志国
彭创
厉鸥
郭超
沈贤波
孙增鹏
易为民
蒋波
Tan Zhiguo;Peng Chuang;Li Ou;Guo Chao;Shen Xianbo;Sun Zongpeng;Yi Weimin;Jiang Bo(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Hunan Normal University(Hunan Provincial People’s Hospital),Clinical and Technical Research Centre for Preventing and Curing Biliary Tract Diseases in Hunan Province,Changsha 410005,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2021年第3期185-187,共3页
Chinese Journal of Hepatobiliary Surgery
基金
湖南省卫计委科研基金(20200179)
湘卫医改医管处便函(〔2019〕118号)。
关键词
腹腔镜检查
肝肿瘤
解剖性切除
外科治疗
Laparoscopy
Liver neoplasms
Anatomical resection
Surgical treatment
