腹腔镜循肝中静脉前入路解剖性右半肝切除35例临床分析
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摘要
目的探讨腹腔镜循肝中静脉前入路解剖性右半肝切除的手术疗效及安全性。方法回顾性分析2015年3月至2017年3月湖南省人民医院肝脏外科35例行腹腔镜循肝中静脉前入路解剖性右半肝切除术患者的临床资料。结果所有患者经术后病理切片明确诊断:肝细胞癌12例(34.3%),肝内胆管细胞癌6例(17.1%),血管平滑肌瘤9例(25.7%),局灶结节性增生3例(8.6%),肝内胆管结石5例(14.3%)。术中情况:无中转开腹,手术时间(268.7±42.3)min,出血量(356.2±138.6)mL。术后情况:术后平均住院(7.8±1.6)d,出现腹腔积液1例(Clavien-Dindo分级I级),胆漏2例(Clavien-Dindo分级II级),胸腔积液合并肺部感染2例(Clavien-Dindo分级II级),均予以保守治疗后康复出院。结论腹腔镜循肝中静脉前入路解剖性右半肝切除术是一种安全的、有效的手术方式。
Objective To investigate the clinical efficacy of laparoscopic anatomical right hepatectomy guided by middle hepatic vein. Methods The clinical data of 35 patients undergone anatomical right hepatectomy from Mar. 2015 to Mar. 2017 were retrospectively analyzed. Results All patiens were confirmed by pathology, the postoperative pathological results showed that: hepatocellular carcinoma was found in 12 patients(34.3%), intrahepatic cholangiocarcinoma in 6 patients(17.1%), vascular smooth muscle in 9 patients(25.7%), focal nodular hyperplasia in 3 patients(8.6%), hepatolithiasis in 5 patients(14.3%). There was no conversion to laparotomy, the operative time was(268.7±42.5) min and intraoperative blood loss was(356.2±138.6) mL. Postoperative complications included ascites(Clavien-dindo grade class I) in 1 patient, bile leakage(Clavien-dindo grade class II) in 2 patients, pleural effusion combined with pulmonary infection(Clavien-dindo grade class II) in 2 patients. The average length of postoperative hospitalization was(7.8±1.6) d. Conclusion Laparoscopic anatomical right hepatectomy guided by middle hepatic vein in anterior approach is a safe and feasible method.
Objective To investigate the clinical efficacy of laparoscopic anatomical right hepatectomy guided by middle hepatic vein. Methods The clinical data of 35 patients undergone anatomical right hepatectomy from Mar. 2015 to Mar. 2017 were retrospectively analyzed. Results All patiens were confirmed by pathology, the postoperative pathological results showed that: hepatocellular carcinoma was found in 12 patients(34.3%), intrahepatic cholangiocarcinoma in 6 patients(17.1%), vascular smooth muscle in 9 patients(25.7%), focal nodular hyperplasia in 3 patients(8.6%), hepatolithiasis in 5 patients(14.3%). There was no conversion to laparotomy, the operative time was(268.7±42.5) min and intraoperative blood loss was(356.2±138.6) mL. Postoperative complications included ascites(Clavien-dindo grade class I) in 1 patient, bile leakage(Clavien-dindo grade class II) in 2 patients, pleural effusion combined with pulmonary infection(Clavien-dindo grade class II) in 2 patients. The average length of postoperative hospitalization was(7.8±1.6) d. Conclusion Laparoscopic anatomical right hepatectomy guided by middle hepatic vein in anterior approach is a safe and feasible method.
引文
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[15]Ogiso S,Conrad C,Araki K,et al.Posterior approach for laparoscopic pancreaticoduodenectomy to prevent replaced hepatic artery injury[J].Ann Surg Oncol,2013,20(9):3120.
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[2]Kanazawa A,Tsukamoto T,Shimizu S,et al.Laparoscopic liver resection for treating recurrent hepatocellular carcinoma[J].J Hepatobiliary Pancreat Sci,2013,20(5):512-517.
[3]尹新民,徐威,成伟,等.“两步分层法”腹腔镜肝左外叶切除术的临床应用价值[J].中华肝脏外科手术学电子杂志,2015,4(6):340-343.
[4]刘荣,赵国栋.肝左外叶切除“金标准”术式:腹腔镜肝左外叶切除术[J].中华腔镜外科杂志电子版,2010,3(6):7-9.
[5]Ciria R,Cherqui D,Geller DA,et al.Comparative short-term benefi ts of laparoscopic liver resection:9000 cases and climbing[J].Ann Surg,2015,263(4):761-777.
[6]Hüscher CG,Lirici MM,Chiodini S,et al.Current position of advanced laparoscopic surgery of the liver[J].J R Coll Surg Edinb,1997,42(4):219-225.
[7]蔡柳新,蔡秀军.腹腔镜右半肝切除术在肝脏疾病治疗中的应用[C].微创外科学术年会,2014.
[8]Ikeda T,Yonemura Y,Ueda N,et al.Pure laparoscopic right hepatectomy in the semi-prone position using the intrahepatic glissonian approach and a modifi ed hanging maneuver to minimize intraoperative bleeding[J].Surg Today,2011,41(12):1592-1598.
[9]龚安安,张成武,周蒙滔.腹腔镜下右半肝切除术治疗右肝肿瘤的围手术期疗效评估[J].肝胆胰外科杂志,2017,29(4):271-275.
[10]陈应军,甄作均,吴志鹏,等.腹腔镜下降肝门板半肝血流阻断在解剖性肝切除术中的应用[J].中华消化外科杂志,2015,14(4):339-343.
[11]蔡柳新,程敏玲,杜学峰,等.选择性半肝血流阻断下腹腔镜右半肝切除术七例[J].中华普通外科杂志,2012,27(6):459-462.
[12]Chen YJ,Zhen ZJ,Chen HW,et al.Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach[J].Hepatobiliary Pancreact Dis Int,2014,13(5):508-512.
[13]Tan J,Tan Y,Zhu Y,et al.Perioperative analysis of laparoscopic liver resection with different methods of hepatic infl ow occlusion[J].J Laparoendosc Adv Surg Tech A,2012,22(4):343-348.
[14]吴同薇,董小玉,郑思婷.肝右动脉和中结肠动脉共干发自肠系膜上动脉变异1例[J].中国临床解剖学杂志,2015,33(3):330-330.
[15]Ogiso S,Conrad C,Araki K,et al.Posterior approach for laparoscopic pancreaticoduodenectomy to prevent replaced hepatic artery injury[J].Ann Surg Oncol,2013,20(9):3120.
[16]Zhang W,Wang J,Li C,et al.Infrahepatic inferior vena cava clamping with Pringle maneuvers for laparoscopic extracapsular enucleation of giant liver hemangiomas[J].Surg Endosc,2017,31(9):3628-3636.