腹腔镜下肝切除术中转开腹的相关因素初步分析

摘要

目的：探讨腹腔镜肝切除术的手术经验、中转开腹相关因素及预防措施。方法：回顾分析2013年11月至2015年11月45例施行腹腔镜肝切除术患者的临床资料，包括是否中转开腹、年龄、性别、术后病理诊断、既往手术史、手术时间、术中出血及住院时间。结果：42例行完全腹腔镜肝切除术，3例中转开腹，其中2例因术中出现不可控的大出血，1例为肿瘤位置不能充分暴露，中转开腹率6．67％。手术时间平均（80±25） min，出血量平均（150±55） ml，术后平均住院（7．1±1．5） d。除术中出血及暴露不充分为腹腔镜肝切除中转开腹的主要因素外，上腹部手术史（P＝0．016）、病程（t＝3．94，P＝0．013）也是中转开腹的相关因素。结论：术中难以控制的出血、手术视野暴露不充分是腹腔镜肝切除术中转开腹的主要原因，上腹部手术史、病程也是中转开腹的因素之一。术前评估患者的既往手术史、病史、肝功能、凝血等情况极为重要，完全腹腔镜下肝切除是安全、有效、微创的术式，但因为肝脏血供丰富、体积较大，对术者技术水平的要求相对较高。%Objective:To evaluate the relative factors for laparoscopic hepatectomy converted to open surgery ,share the opera-tion experience and preventive measures .Methods:A retrospective analysis was made on the clinical data of 45 patients who underwent laparoscopic hepatectomy from Nov .2013 to Nov.2015,including whether they were converted to open surgery ,age,sex,postoperative pathological diagnosis ,previous surgery ,operative time,intraoperative blood loss and hospital stay .Rseults:Totally laparoscopic hepa-tectomy was performed for 42 patients,3 patients were converted to open surgery ,including 2 cases of uncontrollable bleeding and 1 case with deep tumor location which could not be fully exposed , the conversion rate was 6.67%.The average operation time was ( 80 ± 25) min,the average blood loss was (150 ±55) ml,mean postoperative hospital stay was (7.1 ±1.5) d.In addition to the intraopera-tive bleeding and inadequate exposure which were the main factors ,history of abdominal surgery (P=0.016) and course of disease (t=3.94,P=0.013) were the relative factors for conversion from laparoscopic liver resection to laparotomy .Conclusions:Intraoperative uncontrollable bleeding and inadequate exposure are the main reasons of conversion from laparoscopic liver resection to laparotomy ,his-tory of abdominal surgery and course of disease are the relative factors .Preoperative evaluation of previous history of surgery ,course of disease,liver function ,blood coagulation are extremely important ,totally laparoscopic liver resection is a safe ,effective and minimally in-vasive surgery ,but because of rich blood supply and large volume of the liver ,laparoscopic hepatectomy requires relatively higher tech-nology .