Objective To study the safety,feasibility and efficacy of trans-diaphragm thoracoscopic hepatectomy for liver carcinoma.Methods Thoracoscopic hepatectomy was performed in 5 cases with single liver neoplasm from Jan 2016 to Aug 2018,including hepatocellular carcinoma (HCC) in 4 cases and metastatic liver cancer in 1 case.During the operation,the diaphragm just above the tumor was opened.Then we completely removed the tumor.After meticulous hemostasis of cut surface,the diaphragm was closed.A thoracic drain was placed.Results Thoracoscopic hepatectomy was performed successfully in all 5 cases,the median total operating time was 140 min (120-230 min),and the median blood loss was 300 ml (200-500 ml),Patients recovered quickly.One patient had pleural effusion and recovered after chest drainage.There were not other major post-operative complications.During 6 to 31 months' follow-up,one patient was lost to follow-up,two patients were survival with tumor recurrence,two patients were recurrence free.Conclusions Thoracoscopic hepatectomy is a safe and feasible operation in selected liver cancer patients and has advantages in post-operative recovery.%目的 探讨经膈肌入路胸腔镜下膈顶肝脏肿瘤切除的安全可行性.方法 2016年1月至2018年8月,宁波市李惠利东部医院完成5例经膈肌入路膈顶肝脏单发肿瘤切除术.其中4例为原发性肝癌,1例为肝脏转移癌.所有患者术前讨论明确诊断及肿瘤位置,术中B超定位后,打开膈肌,应用腹腔镜器械及开腹器械,完整切除肿瘤.创面止血满意后关闭膈肌,放置引流.结果 5例患者均顺利完成手术,手术时间120～230 min,术中出血量200～500 ml.术后患者恢复顺利,1例术后胸腔积液,引流后好转.术后分别随访6 ～31个月,1例随访6个月后失访,2例肿瘤复发,目前带瘤生存,2例随访无肿瘤复发.结论 针对部分选择性患者,经膈肌入路的肝脏肿瘤切除术是安全可行的.
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