摘要：
Objective To explore the application value of hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy.Methods The clinical data of 15 patients who underwent laparoscopic anatomic hepatectomy by hemi-hepatic blood flow occlusion using descending hilar plate technique at the First People's hospital of Foshan between August 2012 and May 2014 were retrospectively analyzed.The hilar plate was bluntly dissected to expose the left and right Glissonean pedicles.Either side of Glissonean pedicle was tied up with a turnable aspirator with a cotton rope or shoelace and then bypassed the back of hilar plate.Anatomic hepatectomy was performed when hemi-hepatic blood flow was occluded.The follow-up by telephone interview and outpatient examination was done till October 2014.Results Among the 15 patients,the conversion to open surgery was done in 1 patient,Pringle maneuver in 1 patient,and hemi-hepatic blood flow occlusion by descending the hilar plate in 14 patients.Thirteen patients received succesfully laparoscopic anatomic hepatectomy by hemi-hepatic blood flow occlusion using descending hilar plate technique,including 4 of left hemihepatectomy,4 of left lateral lobectomy,2 of right hemihepatectomy,1 of right posterior lobectomy,1 of segment Ⅳ hepatectomy and 1 of segment Ⅵ hepatectomy.Bile duct exploration was applied to 4 patients with left hepatic duct stones and T-tube was placed in 2 patients.Nine and 4 patients received left and right hemi-hepatic blood flow occlusion,respectively.The operation time,mean volume of intraoperative blood loss and time of hemi-hepatic blood flow occlusion in 13 patients were (196 ±63)minutes,320 mL (range,50-1 200 mL) and (51 ± 20)minutes,respectively.The time of descending the hilar plate in 14 patients was (10 ±4)minutes.Among the 13 patients,bile leakage was detected in 1 patient with a maximum volume of drainage of 120 mL/day,liver wound bleeding in 1 patient with a volume of abdominal bloodstained drainage of 400 mL at postoperative day 2.Two patients were cured by conservative treatment,and no liver failure and perioperative death were occurred.The duration of hospital stay was (6.9 ± 2.4)days.Among the 15 patients,2 patients were loss to follow-up and other patients were followed up for 5-26 months with good survival,1 patient died.Conclusion Hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy is safe and feasible.%目的 探讨腹腔镜下降肝门板半肝血流阻断在解剖性肝切除术的应用价值.方法 回顾性分析2012年8月至2014年5月佛山市第一人民医院收治的15例采用腹腔镜下降肝门板半肝血流阻断行解剖性肝切除术患者的临床资料.全身麻醉下,采用4孔或5孔法进入腹腔,钝性分离肝门板,显露左右Glisson鞘,采用可转弯吸引器带棉绳或鞋带绕过肝门板,捆绑半肝Glisson鞘,在阻断半肝入肝血流下行解剖性肝切除术.采用电话和门诊随访,随访时间截至2014年10月.结果 15例患者中,1例肝癌患者中转开腹;14例患者采用下降肝门板行半肝血流阻断,1例患者改用Pringle法阻断.13例成功采用腹腔镜下降肝门板半肝血流阻断行解剖性肝切除术,其中行左半肝切除术4例,肝左外叶切除术4例,右半肝切除术2例,肝右后叶切除术1例,肝Ⅳ段切除术1例,肝Ⅵ段切除术1例.4例左肝内胆管结石患者联合胆道探查,2例留置T管.13例患者血流阻断:左半肝血流阻断9例,右半肝血流阻断4例.13例患者手术时间为(196 ± 63) min,13例患者半肝血流阻断时间为(51 ± 20) min.14例患者下降肝门板时间为(10±4) min.13例患者术中平均出血量为320 mL(50 ～1 200 mL).13例患者中,术后胆汁漏1例,腹腔引流管引流量最大为120 mL/d;肝创面出血1例,术后第2天腹腔引流管引出血性液体400 mL.2例患者均经保守治疗痊愈.术后无肝衰竭和围术期死亡患者.术后住院时间为(6.9±2.4)d.15例患者中,2例失访,其余随访时间为5 ～26个月,1例死亡,其余生存.结论 采用腹腔镜下降肝门板半肝血流阻断行解剖性肝切除术是安全、可行的.
