腹腔镜肝切除治疗肝脏疾病的178例分析

Clinical analysis of laparoscopic hepatectomy for the treatment of hepatic diseases (178 cases)

摘要:

目的  探讨腹腔镜肝切除治疗肝脏疾病的可行性。方法  回顾性分析2005年3月-2014年8月温州医科大学附属台州医院采用腹腔镜肝切除术治疗178例肝脏疾病患者。其中，肝血管瘤74例，肝内胆管结石45例，原发性肝癌43例，结节局灶性增生8例，肝囊肿3例，肝脓肿2例，肝破裂2例，错构瘤1例。所有患者采用电话和门诊随访，随访时间截止至2014年11月。结果  178例患者中单个肝段切除者50例、跨肝段切除者126例、多发肿瘤切除者2例。76例行肿瘤切除合并胆囊切除。153例获得成功，25例中转开腹，平均手术时间（278.9±128.0）min；术中出血量10～5 000 ml；20例术中输血；术后平均住院时间（11.6±6.5）d；肝功能恢复时间（6.0±3.0）d。2例出现胆漏，5例出现腹腔积液。原发性肝癌患者随访率100.0%，随访时间（24.6±19.7）个月。结论  腹腔镜肝切除手术治疗肝脏疾病是安全可行的。在对第一、二、三肝门进行正确处理、进行选择性阻断入肝血流、腹腔镜断肝设备不断改进的情况下，可提高腹腔镜肝切除术的安全性。

Abstract:

【Objective】 To investigate the feasibility of laparoscopic hepatectomy for the treatment of hepatic diseases. 【Method】 Retrospective analysis of the clinical data from March 2005 to August 2014, the 178 cases of hepatic diseases who received laparoscopic hepatectomy at the Affiliated Taizhou Hospital of Wenzhou Medical University. There were hepatic hemangioma (74 patients), hepatolithiasis (45 patients), primary hepatic carcinoma (43 patients), focal nodular hyperplasia (8 patients), hepatic cyst (3 patients), hepatic abscess (2 patients), hepatorrhexis (2 patients), hamartoma (1 patient). All patients were followed up via phone or outpatient department. The follow-up ended in November 2014. 【Result】 A total of 178 cases received laparoscopic hepatectomy, 50 patients received single hepatic segmentectomy, 126 cases received multiple hepatic segmentectomy, 2 cases received multiple lesions resection. 76 cases received hepatic tumorectomy + cholecystectomy. 153 patients were successfully performed laparoscopic hepatectomy and 25 conversions to laparotomy. The median operative time was 278.9 min (75～690 min), the mean operation time was (278.9 ± 128.0) min; the median intraoperative blood loss was 10~5 000 ml; 20 cases with intraoperative blood transfusion, the duration of postoperative hospital stay was (11.6 ± 6.5) d; the recovery times of hepatic function was (6.0 ± 3.0) d. 2 cases were complicated with bile leakage, 5 cases with seroperitoneum, other patients had no postoperative complications. The rate of follow-up was 100% with primary hepatic carcinoma, meanwhile the time of follow-up was (24.6 ± 19.7) m. 【Conclusion】 Laparoscopic hepatectomy for the treatment of hepatic diseases is safe and feasibility. Dissecting the first, second and third hepatic portal, selective blocking hepatic blood flow, continuous improvement of hepatectomy equipment improve the safety of surgery.