经Laennec膜左侧肝实质优先入路结合“APR三角”在腹腔镜解剖性中央肝段切除中的应用

Application of Laennec membrane left side hepatic parenchymal transection-first approach combined with APR triangle in laparoscopic anatomical central hepatectomy

摘要:

目的 探讨经Laennec膜左侧肝实质优先入路结合“APR三角”在腹腔镜解剖性中央肝段切除术中应用的安全性和临床疗效。方法 回顾性分析2023年1月－2024年6月于该院行腹腔镜解剖性中央肝段切除术的24例患者的临床资料，患者均采用经Laennec膜左侧肝实质优先入路结合“APR三角”切除。统计分析手术时间、术中出血量、术后并发症和住院时间等。结果 24例患者均完成腹腔镜解剖性中央肝段切除术，无围手术期死亡病例。手术时间为95～295 min，平均为（210.2±75.6）min，术中出血量为150～1 100 mL，平均为（358.9±118.4）mL，无术中输血和中转开腹。术后4～10 d拔除腹腔引流管，平均为（5.5±0.5）d，术后住院时间为5～16 d，平均为（7.5±1.5）d。术后出现Clavien-Dindo Ⅰ级和Ⅱ级并发症5例，包括4例腹腔积液和1例胸腔积液。术后病理均为肝细胞肝癌。对于肝恶性肿瘤患者，术后随访1个月至1年6个月，随访期内患者均存活，肿瘤复发2例。结论 采用经Laennec膜左侧肝实质优先入路结合“APR三角”在腹腔镜解剖性中央肝段切除中是安全可行的。值得临床推广应用。

Abstract:

Objective To investigate the safety and clinical efficacy of the Laennec membrane left side hepatic parenchymal transection-first approach combined with APR triangle in laparoscopic anatomical central hepatectomy.Methods 24 patients underwent laparoscopic anatomical central hepatectomy via Laennec membrane left side hepatic parenchymal transection-first approach combined with APR triangle from January 2023 to June 2024 were selected. Statistical analysis of patients with operation time, intraoperative blood loss, postoperative complications, and postoperative hospital stay.Results All the 24 patients underwent laparoscopic anatomical central hepatectomy without perioperative death. The operation time was (210.2 ± 75.6) minutes (range: 95 ~ 295 min), and the intraoperative blood loss was (358.9 ± 118.4) mL (range: 150 ~ 1 100 mL). There was no intraoperative blood transfusion and no conversion to open surgery. The abdominal drainage tube was removed on the average of (5.5 ± 0.5) d (range: 4 ~ 10 d) after operation, and the average postoperative hospital stay was (7.5 ± 1.5) d (range: 5 ~ 16 d). There were 5 cases of Clavien-Dindo grade Ⅰ and Ⅱ complications, including 4 cases of abdominal effusion and 1 case of pleural effusion. Postoperative pathology: all patients were hepatocellular carcinoma. Patients with liver malignant tumor were followed up for 1 month to 1.5 years. All the patients survived during the follow-up period, and 2 patients had tumor recurrence.Conclusion For central hepatic segment tumors, laparoscopic anatomical central hepatectomy can be performed using the left hepatic parenchyma via Laennec membrane priority approach combined with APR triangle method, which is safe and feasible.