一种理想的腹腔镜下肝硬化肝癌切除方法： HabibTM 4X联合血管夹

An ideal technique of laparoscopic hepatectomy for hepatocellular carcinoma with liver cirrhosis: HabibTM 4X combined vascular clips

摘要:

目的 探讨HabibTM 4X联合血管夹在腹腔镜肝硬化肝癌切除术中的临床应用价值。方法 回顾性分析2010年10月～2013年5月该院应用HabibTM 4X联合血管夹行腹腔镜肝硬化肝癌切除32例的临床资料，并对所有病例跟踪随访。结果 31例成功完成完全腹腔镜手术，1例中转开腹。其中有15例不规则肝切除，13例肝左外叶切除，3例解剖性左半肝切除。手术时间45～360 min，平均（165±67）min。出血量10～900 ml，（168±177）mL。无死亡病例。1例术后发生脐缘穿刺孔处肝圆韧带出血；1例发生肺部感染，无肝断面出血、胆漏、肝功能衰竭和腹腔脓肿等术后并发症。术后住院时间5～14 d，平均（9±2）d。31例随访3～28个月，平均12个月，无死亡病例。4例肝细胞癌分别术后2、4、5和8个月后出现肝内转移复发，1例肝细胞癌术后5个月出现肝内以及肺部转移，均行TACE治疗；余26例无肿瘤复发及转移。结论 HabibTM 4X联合血管夹在肝硬化肝癌中是一种安全、可靠且理想的腹腔镜断肝方法，其合理使用可明显降低出血以及胆漏等并发症发生的风险性。

Abstract:

【Objective】 To investigate the application of HabibTM 4X combined vascular clips in laparoscopic hepatectomy for hepatocellular carcinoma with liver cirrhosis. 【Methods】 From October 2010 to May 2013, laparoscopic hepatectomy for primary carcinoma with liver cirrhosis was performed with the HabibTM 4X combined vascular clips in 32 patients in our hospital. The clinical data including preoperative characteristics, postoperative data and short-time follow up outcomes were retrospectively evaluated. 【Results】 31 cases were successful in laparoscopic surgery, while 1 case converted to laparotomy. Among these, 15 cases were subject to irregular hepatectomy, 13 left lateral lobe resection and 3 anatomical left hepatectomy. The mean surgery time was (165±67) min (range, 45~360 min); mean blood loss was (168±177)mL (range, 10~900 mL). No patient died. 1 patient postoperatively bled in the round ligament of the liver at the puncture hole in the umbilical edge and 1 patient had pulmonary infection.No patients experienced other postoperative complications such as bleeding from liver resection margins, bile leakage, liver failure and abdominal abscess. The mean hospital stay after surgery was (9±2)d (range, 5~14 d). The median follow-up period was 12 months for 31 patients: 4 cases had tumor recurrence with intrahepatic metastasis in postoperative 2, 4, 5 and 8 months, 1 case was found with metastases in the liver and the lung in postoperative 5 months to which TACE was applied, and the remaining 26 cases were without tumor recurrence and metastasis. 【Conclusion】 HabibTM 4X combined vascular clips are a safe, reliable and ideal technique of laparoscopic hepatectomy for hepatocellular carcinoma with liver cirrhosis with a significantly low risk of intraoperative bleeding or postoperative complications such as bile leak.