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腹腔镜治疗中央型肝肿瘤的探讨(附40例报告)

Exploration on laparoscopic hepatectomy on central liver tumor:a report of 40 cases

摘要:

目的 探讨腹腔镜在中央型肝肿瘤围手术期治疗中的安全性和可行性.方法 回顾性收集2016年1月至2018年12月湖南省人民医院肝胆外科应用腹腔镜技术治疗的40例中央型肝肿瘤患者的临床资料.男性19例,女性21例,年龄(59.5±14.5)岁(范围:15~71岁).其中原发性肝癌26例(肝细胞癌24例、胆管细胞癌2例),肝海绵状血管瘤8例,转移性肝癌1例,肝细胞腺瘤5例.肿瘤最大径(6.2±2.9)cm(范围:2~13 cm).收集患者的肝脏切除方式、血流阻断方式及时间、手术时间、术中出血量、术中输血率、术后住院时间、围手术期再手术情况、术后并发症情况.结果 40例患者均在腹腔镜下完成手术,其中右半肝(Ⅴ、Ⅵ、Ⅶ、Ⅷ段)切除术2例,左半肝(Ⅱ、Ⅲ、Ⅳ段)切除术2例,肝中叶切除术(Ⅳ、Ⅴ、Ⅷ段)13例,左三肝(Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅷ段)切除术2例,右三肝(Ⅳ、Ⅴ、Ⅵ、Ⅶ、Ⅷ段)切除术2例,Ⅷ段切除术7例,Ⅳ段切除术1例Ⅴ、Ⅷ段切除术3例,单纯尾状叶(Ⅰ、Ⅸ段)切除术5例,局部肿瘤切除术3例.病理学检查结果显示,原发性肝癌26例(肝细胞癌24例、胆管细胞癌2例),肝海绵状血管瘤8例,转移性肝癌1例,肝细胞腺瘤5例;所有恶性肿瘤病例的病理报告均显示切缘为阴性.手术时间(333±30)min(范围:280~380 min);术中肝门阻断时间(58±13)min(范围:30~90 min);术中出血量(173±129)ml(范围:20~600 ml);术中输血率为2.5% (1/40);术后胆瘘发生率为2.5%(1/40),1例胆瘘患者经T管减压及充分引流等保守治疗后出院;发生腹部感染1例、肺部感染1例,均保守治疗痊愈后出院;无其他严重并发症发生.术后住院时间(10.7±2.7)d(范围:6~16d);围手术期内无死亡病例及再手术病例.结论 在具有丰富腹腔镜肝切除经验的中心,对病例进行高度选择,做好充分的术前评估,选择合理的术式入路,腹腔镜应用在中央型肝肿瘤的围手术期治疗中是安全可行的.

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abstracts:

Objective To assess the safety and feasibility of the application of the laparoscopic modality in the perioperative treatment of central liver tumors.Methods Collecting all the clinical information of a total of 40 patients with central liver tumors who received laparoscopic resection treatment carried out at Department of Hepatological Surgery of People's Hospital of Hunan Provincial from January 2016 to December 2018 to take a retrospective review.There were 19 males and 21 females.The age was (59.5 ± 14.5)years(range:15 to 71 years).There were 26 cases of primary hepatic carcinoma(24 cases of hepatocellular carcinoma,2 cases of cholangiocellular carcinoma),8 cases of hepatic cavernous hemangioma,1 case of metastatic hepatic carcinoma,5 cases of hepatocellular adenoma.The maximum diameter of tumors were (6.2±2.9)cm(range:2 to 13 cm).The patient's information about hepatectomy methods,blocking mode and time of blood flow,operation time,intraoperative blood loss,intraoperative blood transfusion rate,post-operative hospitalization time,perioperative reoperation and postoperative complications were collected.Results A total of 40 patients all were treated with laparoscopic surgery.The surgical procedure was as follows:2 patients received the right hepatic lobectomy (Ⅴ,Ⅵ,Ⅶ and Ⅷ segments),2 patients received the left hepatic lobectomy (Ⅱ,Ⅲ and Ⅳ segments),13 patients received mesohepatectomy (Ⅳ,Ⅰ and Ⅷ segments),2 patients received left hepatic trisegmentectomy (Ⅱ,Ⅲ,Ⅳ and Ⅷ segments),2 patients received right hepatic trisegmentectomy (Ⅳ,Ⅴ,Ⅵ,Ⅶ and Ⅷ segments),7 patients received Ⅷ segmentectomy,1 patient received Ⅳ segmentectomy,3 patients received Ⅴ and Ⅷ segmentectomy,5 patients received hepatic caudate lobe resection(Ⅰ,Ⅸ segments),and 3 patients received local tumors resection.Pathological results:there were 26 cases of primary hepatic carcinoma(24 cases of hepatocellular carcinoma,2 cases of cholangiocellular carcinoma),8 cases of hepatic cavernous hemangioma,1 case of metastatic hepatic carcinoma,5 cases of hepatocellular adenoma;the pathological reports of all malignant tumor cases all showed negative incisal edge.The operative time was (333±30)minutes(range:280 to 380 minutes);the intraoperative hepatic portal occlusion period was (58± 13)minutes(range:30 to 90 minutes);the intraoperative hemorrhage was (173 ± 129)ml(range:20 to 600 ml);the intraoperative blood transfusion rate was 2.5%(1 / 40);the postoperative incidence of bile leakage was 2.5%(1/40),the hospital discharge of 1 patient with bile leakage was approved after conservative treatments like T pipe decompression and adequate drainage;there was 1 case of abdominal infection and 1 case of pulmonary infection,both of which were discharged from the hospital with conservative treatments;there were no other serious postoperative complications.The postoperative hospital stay was (10.7±2.7)days(range:6 to 16 days);there were no perioperative mortality and reoperation cases.Conclusion In the centers with abundant laparoscopic hepatectomy experiences,the laparoscopic resection is proved to be safe and feasible in the perioperative treatments of central liver tumors by the highly selective cases,the adequate preoperative assessment and reasonable surgical techniques and approach.

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作者: 朱斯维 [1] 尹新民 [1] 姚立波 [1] 刘毅 [1] 廖春红 [1] 吴一飞 [1] 李云峰 [1] 蔡荣耀 [1] 彭创 [1]
第一作者: 朱斯维
期刊: 《中华外科杂志》2019年57卷7期 517-522页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2019.07.008
发布时间: 2019-07-25
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