腔镜肝切除术治疗肝恶性肿瘤74例

摘要

Objective To explore the clinical technology of completely laparoscopic or thoracoscopic hepodectomy in treatment of malignant hepatic neoplasm.Methods From June 2006 to September 2011,74 cases underwent laparoscopic or thoracoscopic hepatectomy for malignant hepatic neoplasm.Data including operating time,blood loss and postoperative complications,etc,were analyzed retrospectively.Liver parenchyma was transected using laparoscopic ultrosonic scalpel,ligasure,and endoscopic linear stapler.Results Postoperative pathology revealed primary liver carcinoma (46 cases),colon carcinoma with liver metastasis (27cases),pancreatic non-function neuroendocrine carcinoma with liver metastasis (1 case).The operations included (1) laparoscopic:left hemihepatectomy (n =15),left lateral lobectomy (n =21),right hemihepatectomy (n =9),segmentectomy (n =13),local resection (n =28) ; (2) thoracoscopic hepatectomy (n =3).Mean blood loss was (210 ± 134) ml (range 25-1080 ml),mean surgical time was (155 ± 62) min (range 51-245 minutes),mean postoperative hospital stay was (7.1 ± 1.9) days (range 3-14 days).Postoperative complications included bile leakage in six cases,recovered after 1-2 weeks by appropriate draining.The patients with malignant tumor were followed up for (20.5-±9.5) months (range 13-53 months),recurrence happened in 19 cases and eight cases died of recurrence and metastasis.Conclusions Laparoscopic or thoracoscopic hepatectomy is a safe,feasible and effective procedure for the treatment of malignant liver neoplasm in selected patients.Thoracoscopic hepatectomy is suitable for tumors lying in upper part of the right liver with severe adhension in abdominal cavity.%目的 探讨腔镜肝切除术在治疗肝脏恶性肿瘤中的应用价值.方法 回顾分析2006年6月至2011年9月间74例施行腔镜肝切除术患者手术时间、术中失血量、术后并发症等.断肝方式为超声刀+ LigaSure联合分离法,结合腔镜下切割缝合器.结果 术后病理证实原发性肝癌(PLC) 46例,大肠癌肝转移27例,胰腺无功能神经内分泌癌肝转移1例.术式包括:经腹腔镜左半肝切除15例、左外叶切除21例、肝段切除13例、右半肝切除9例、局部切除28例(合并左半肝切除4例,合并左外叶切除5例,合并右半肝切除3例,合并肝段切除3例)；经胸腔镜、经膈肌肝局部切除3例.手术时间51 ～ 245 min,平均(155±62)min,术中出血量25 ～ 1080 ml,平均(210±134) ml.6例术后发生胆漏,经充分引流1～2周治愈.术后住院时间3～14d,平均(7.1±1.9)d.术后随访13 ～53个月,平均(20.5±9.5)个月,肿瘤复发19例,其中8例因肿瘤复发转移死亡.结论 在病例选择适当时,腔镜下肝切除术是一种安全、有效、微创的手术,适用于肝脏恶性肿瘤,能达到根治要求.经胸腔镜经膈肌肝局部切除适用于腹腔粘连严重的右肝上段局部肿物.