腹腔镜肝切除术15例报告
周党军 王 羊 贾蓬勃 晁延军 韩博强 蒋安安 安东均
摘 要
目的：探讨腹腔镜肝切除术的适应证及可行性。
方法：回顾分析2010年12月～2013年12月为15例肝占位性病变患者行完全腹腔镜肝切除术的临床资料。
结果：13例成功完成腹腔镜肝切除术，2例中转开腹。原发性肝癌5例，肝海绵状血管瘤5例，肝内胆管结石2例，肝囊肿2例，肝血管平滑肌脂肪瘤1例。其中行局部切除术8例，左肝外叶切除术5例，肝囊肿切除2例；合并腹腔镜胆囊切除术2例。手术时间平均（153±53）min，术中出血量平均（412±93）mL，切除病灶最大直径12 cm。肿瘤均完整切除，包膜完整，无破裂。1例术后发生胆漏，保守治疗后痊愈；2例术后出血，经对症治疗后痊愈，无死亡病例，术后平均住院（10±3）d。
结论：位于肝脏边缘、右肝表面或肝左外叶（Ⅱ～Ⅵ段）的肝脏占位性病变，行腹腔镜肝切除术是安全、可行的。
关键词
肝肿瘤；肝切除术；腹腔镜检查
Laparoscopic hepatectomy:a clinical report of 15 cases
ZHOU Dangjun，WANG Yang，JIA Pengbo，et al.1.Department of Hepatobiliary Surgery，Xianyang Center Hospital，Xianyang 712000，China；2.Xianyang No.1 Renmin Hospi-tal
ABSTRACT
Objective:To evaluate the indication and feasibility of laparoscopic hepatectomy.
Methods:The clinical data of 15patients with space occupying lesions of liver undergone pure laparoscopic hepatectomy from Dec.2010 to Dec.2013 were retrospectively analyzed.
Results:All 13 patients were applied pure laparoscopic hepatectomy successfully，with 2 conversion to open surgery，including 5 cases of primary liver cancer，5 cases of liver cavernous hemangioma，2 cases of hepatolithiasis，2 cases of hepatic cyst，1 case of hepatic angiomyolipoma.8 of all were performed partial resection，5 cases underwent laparoscopic hepatic left lateral lobectomy，2 cases underwent resection of cyst of liver.2 cases combined with laparoscopic cholecystectomy.The average operation time was（153±53）min，and the intraoperative average hemorrhage was（412±93）ml.The maximum diameter of tumor was 12 cm.All of the tumors were removed en bloc，with intact capsule.One with postoperative bile leakage and two with postoperative hemorrhage were cured by conservative management.The other patients recovered well，no death case.The average postoperative hospital stay was（10±3）d.
Conclusions:Laparoscopic hepatectomy is safe and feasible for tumor located in the edge of liver，the surface of the right liver and left lateral liver（Ⅱ-Ⅵ segment）.
KEY WORDS
Liver neoplasm；Hepatectomy；Laparoscopy
腹腔镜肝脏切除术自1991年由Reich等［1］首次报道以来，其在肝脏外科中的应用发展较快。随着腹腔镜技术的逐渐成熟及人们对肝脏解剖认识的更加完善，腹腔镜肝脏切除术的可行性、安全性逐渐得到认可，而其微创优势在临床实践过程中被不断提高并得以充分体现。2010年12月至2013年12月我院为15例患者行完全腹腔镜肝切除术，手术疗效可靠。现将结果报道如下。