双极射频Habib 4X在完全腹腔镜肝切除术中的应用

摘要

Objective To evaluate the application value of bipolar radiofrequency device (Habib 4X) for total laparoscopic hepatectomy. Methods From February 2011 to March 2012, we performed total laparoscopic hepatectomy with Habib 4X on 12 patients in our hospital. The laparoscopic Habib 4X was introduced into the liver to coagulate necrotic liver parenchyma and close the biliary ducts and blood vessels, so that to resect the liver tissues. The lesions were removed by coagulation while cutting. Results The operation was completed successfully in all the patients without hepatic pedicle clamping. The procedures included 7 cases of local hepatectomy and 5 cases of left external lobe hepatectomy. The mean operation time was (129 ±39) min (range, 80 -210 min) , and the mean blood loss was (72 ±55) ml (range, 10 -200 ml). No patient died during postoperative hospital stay (ranged from 5 to 14 days with a mean of 8.5 days). One patient showed ligamentum teres hepatis hemorrhage at the umbilical puncture site, and therefore received an emergency operation for intra-abdominal exploration. No bleeding at the liver resection margins, bile leakage, intra-abdominal abscess, or liver failure occurred in this series. Postoperative pathological examination showed 7 cases of hepatocellular carcinoma, 3 cases of cavernous hemangioma, 1 case of liver cirrhosis, and 1 case of intrahepatic bile duct stones complicated with chronic cholangitis. The patients were followed up for 1 to 14 months with a mean of 6 months, during which, one patient with intrahepatic bile duct stones showed no recurrence or residual stones; and the two patients with hepatocellular carcinoma were diagnosed with intrahepatic metastasis in 2 and 8 months respectively, and therefore both received TACE. No recurrence or metastasis occurred in the other 9 patients. Conclusions Habib 4X is feasible, safe and effective for total laparoscopic hepatectomy.%目的 探讨双极射频凝固电极Habib 4X在腹腔镜肝切除术中的临床应用价值. 方法 2011年2月～2012年3月,应用Habib 4X完成完全腹腔镜肝切除12例,Habib 4X插入肝实质使肝组织凝固坏死以及脉管封闭后再切肝,采用边凝固边切开的方法,逐步切除病灶. 结果 12例手术成功,其中7例行局部不规则肝切除,5例行肝左外叶切除,均未行肝门阻断.手术时间80 ～210 min,(129±39)min.出血量10～200 ml,(72±55)ml.无死亡病例.1例术后发生脐缘穿刺孔处肝圆韧带出血,急诊开腹探查止血；无肝断面出血、胆漏、腹腔脓肿、肝功能衰竭等术后并发症.术后住院时间5～14d,平均8.5d.术后病理病诊断:7例肝细胞癌,3例海绵状血管瘤,1例肝硬化增生结节,1例肝内胆管结石合并胆管慢性炎症.12例随访1～14个月,平均6个月:1例肝内胆管结石未见结石残留或复发；2例肝细胞癌分别术后2、8个月后出现肝内转移复发,均行TACE治疗；余9例无肿瘤复发、转移. 结论 Habib 4X应用于选择病例的腹腔镜肝切除是一种安全、可行、有效的切肝方法,值得临床推广.