中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (12): 1025-1027.

• 论著 • 上一篇    下一篇

选择性半肝血流阻断在腹腔镜肝切除中的应用

李建伟，郑树国，陈 健，邓 昊，别 平，王曙光   

  1. 第三军医大学西南医院全军肝胆外科研究所，重庆，400038
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-12-18 发布日期:2009-12-18

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-12-18 Published:2009-12-18

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摘要：

目的 探讨腹腔镜肝切除中选择性半肝血流阻断方法的技术要点、有效性及可行性。方法 回顾性分析第三军医大学西南医院肝胆外科研究所2007?03?01~2008?09?30 37例行选择性半肝血流阻断下腹腔镜肝切除术病人的临床资料。结果 右半肝血流阻断11例（联合右肝静脉阻断6例），左半肝血流阻断26例（联合左、中肝静脉阻断18例），手术方式包括左半肝切除20例，超左半肝切除1例，左外叶切除5例，右半肝切除4例，右后叶切除2例，Ⅵ段切除3例，不规则切除2例（Ⅴ、Ⅵ部分切除），联合胆道探查＋T管引流12例，阑尾切除1例。手术时间平均190（110～490）min，平均出血量340（100～1200 ）mL。术中右肝静脉损伤1例中转开腹，术后右侧胸腔积液2例，肝断面包裹性积液2例。结论 选择性半肝血流阻断对于腹腔镜下肝切除术是有效可行的肝血流阻断方法。适用于腹腔镜下解剖性半肝切除及合并肝硬化病人的肝切除等。

关键词: 选择性半肝血流阻断, 腹腔镜, 肝切除

Abstract:

Application of selective hemihepatic blood flow occlusion in laparoscopic hepatectomy LI Jian-wei,ZHENG Shu-guo,CHEN Jian,et al.Institute of Hepatobiliary Surgery of PLA,Southwest Hospital,the Third Military Medical University,Chongqing 400038,China Corresponding author: ZHENG Shu-guo, E-mail：shuguozh@yahoo.com.cn Abstract Objective To discuss the technical outline,the effectivity and the feasibility of selective hemihepatic blood flow occlusion in laparoscopic hepatectomy. Methods Thirty-seven patients performed by laparoscopic hepatectomy with selective hemihepatic blood flow occlusion between March 1, 2007 and September 30, 2008 in the Institute of Hepatobiliary Surgery of PLA,Southwest Hospital of the Third Military Medical University were investigated retrospectively. Results Eleven patients were treated with right hemihepatic blood flow occlusion and 6 of whom underwent right hepatic vein occlusion. Twenty-six patients were treated with left hemihepatic blood flow occusion and 18 of whom underwent middle and left hepatic vein occlusion. Twenty patients were performed left hemihepatectomy. One patient performed extended left hemihepatectomy. Five patients performed left lateral segmentectomy. Four patients performed right hemihepatectomy. Two patients performed right posterior lobe resection. Three patients performed segment Ⅵ resection and 2 patients performed local resection (part of Ⅴ and Ⅵ). Among those procedure, 12 patients combined with biliary track exploration and T-tube drainage and 1 patient combined with appendectomy. The mean operation time was 190 minutes (110—490 minutes). The mean bleeding volume was 340 minutes (100—1200mL). A conversion to open surgery was required in 1 patient because of injury of right hepatic vein. Right hydrothorax and encapsulated effusion on liver cross section developed in two each. Conclusion Selective hemihepatic blood flow occlusion in laparoscopic hepatectomy is an effective and feasible technique.It is applied to laparoscopic hemihepatectomy and laparoscopic hepatectomy for cirrhotic patients.

Key words: selective hemihepatic blood flow occlusion, laparoscopy, hepatectomy