论文部分内容阅读
目的:探讨完全腹腔镜解剖性肝Ⅷ段切除的策略、安全性及近期疗效。方法:回顾分析湖南省人民医院2015年1月至2019年12月行腹腔镜解剖性肝Ⅷ段切除9例患者资料，其中男性6例，女性3例，年龄范围29～67岁，平均年龄53.6岁。观察手术时间、术中失血量、术后住院时间、术后并发症等指标。出院后随访生存和复发情况。结果:9例患者均在腹腔镜下完成解剖性肝Ⅷ段切除。手术时间140～240 min，平均188.9 min。术中失血量20～300 ml，平均117.8 ml。1例术后出现胸腔积液，保守治疗治愈；1例出现腹水，延迟拔管治愈。9例患者均无Clavien-Dindo Ⅲa级以上并发症。无围手术期死亡。术后住院时间3～12 d，平均6.9 d。术后病理结果：肝细胞腺瘤2例、肝细胞癌4例、胆管细胞癌1例、转移性肝癌2例。9例患者均获随访，随访12～58个月，中位随访时间22个月。1例原发性肝癌患者术后18个月复查发现肝内复发，行微波消融治疗，其余未见明显复发征象。结论:在充分术前评估、合理病例选择、严谨手术规划、娴熟腹腔镜操作技术的前提下，腹腔镜肝Ⅷ段切除安全可行，近期疗效优良。“,”Objective:To study the feasibility, safety and technique for laparoscopic anatomical liver resection of segment 8.Methods:The clinical data of 9 patients who underwent laparoscopic anatomical liver resection of segment 8 from January 2015 to December 2019 at Hunan Provincial People's Hospital were retrospectively analyzed. There were 6 males and 3 females, with age ranging from 29 to 67 years (average 53.6 years). The operation time, intraoperative blood loss , postoperative hospital stay, postoperative complications, and long-term survival and recurrence rates on follow-up were analysed.Results:Laparoscopic anatomical liver resection of segment 8 was successfully carried out in these patients. The mean operative time was 188.9 min(range 140-240 min). The mean estimated intraoperative blood loss was 117.8 ml (range 20-300 ml). The postoperative hospital stay was 6.9 days (range 3-12 days). One patient developed pleural effusion after operation and responded to conservative treatment. Another patients developed ascites with delayed extubation. The patient was successfully treated with conservative treatment. No patients developed complications above Clavien Dindo Ⅲa. There were no perioperative deaths. The postoperative pathological results showed hepatocellular adenoma (n n=2), hepatocellular carcinoma (n n=4), cholangiocarcinoma (n n=1), and metastatic liver cancer (n n=2). On follow-up for 12-58 months (median 22 months) one patient with hepatocellular carcinoma developed recurrence at 18 months after operation and was treated with microwave ablation. The other patients were well on follow-up.n Conclusions:With adequate preoperative evaluation, reasonable case selection, rigorous surgical planning, and skilled laparoscopic techniques, laparoscopic anatomical liver resection of segment 8 was safe and feasible, and the short-term efficacy was good in this study.