CAJ | 학술논문

目的探讨经胸腔内镜下肝脏肿瘤切除的可行性、安全性和疗效.方法 2007-2011年,北京大学第三医院完成3例经胸腔内镜下肝脏单发肿瘤切除术.其中1例为原发性肝癌,2例为肝脏转移癌.术前通过影像检查对肿物进行三维定位,以确定术中套管的位置.患者置于左侧卧位,在肿瘤周围的胸壁放置3个套管.内镜超声确认肿物位置后打开膈肌,在肝脏表面内镜超声再次明确肿物边界并标记切除线.依照标记逐步切开肝脏组织,切除过程中反复行内镜超声确认肿瘤位置和切除深度,以保证肿瘤的完整切除.创面止血满意后关闭膈肌,放置胸腔引流.结果 3例患者均顺利完成手术,手术时间110～210min,平均150 min,术中出血量130～600 ml,平均297 ml.术后患者恢复顺利,无并发症.术后分别随访9～42个月,1例死于其他疾病,所有患者均无肿瘤复发.结论对于特定的病例,经胸腔内镜下肝脏肿瘤切除术安全、可行,在术后并发症、住院时间等方面有明显的优势.
목적 탐토경흉강내경하간장종류절제적가행성、안전성화료효.방법 2007-2011년,북경대학제삼의원완성3례경흉강내경하간장단발종류절제술.기중1례위원발성간암,2례위간장전이암.술전통과영상검사대종물진행삼유정위,이학정술중투관적위치.환자치우좌측와위,재종류주위적흉벽방치3개투관.내경초성학인종물위치후타개격기,재간장표면내경초성재차명학종물변계병표기절제선.의조표기축보절개간장조직,절제과정중반복행내경초성학인종류위치화절제심도,이보증종류적완정절제.창면지혈만의후관폐격기,방치흉강인류.결과 3례환자균순리완성수술,수술시간110～210min,평균150 min,술중출혈량130～600 ml,평균297 ml.술후환자회복순리,무병발증.술후분별수방9～42개월,1례사우기타질병,소유환자균무종류복발.결론 대우특정적병례,경흉강내경하간장종류절제술안전、가행,재술후병발증、주원시간등방면유명현적우세.
Objective To study the safety,feasibility and efficacy of thoracoscopic hepatectomy for liver carcinoma. Methods Thoracoscopic hepatectomy was performed in 3 cases with single liver neoplasm from 2007 to 2011,including hepatocellular carcinoma ( HCC ) in one case and metastatic liver cancer in 2 cases.By preoperative imaging the tumor was located accurately to simulate the port position in operation.Patients were placed in a left lateral decubitus position,and 3 ports were inserted into the chest wall surrounding the tumor. Through the use of intra-operative thoracoscopic uhrasonography (IOTU),the diaphragm just above the tumor was opened.IOTU was performed on the liver surface and the resection line was marked.Throughout the course of parenchymal transection,IOTU was performed repeatedly to guide the resection line,and ensure the complete removal of the tumor.After meticulous hemostasis of the resection surface,the diaphragm was closed. A thoracic drain was left. Results Thoracoscopic hepatectomy succeeded in all 3 cases,the median total operating time was 150 min (110 -210 min),and the medianblood loss was 297 ml (130 -600 ml). Patients recovered quickly and had no major post-operative complications.During 9 to 42 months' follow-up,one patients died of other cause,no relapse of the diseases was found. Conclusions Thoracoscopic hepatectomy is a safe and feasible operation in selected patients and has advantages in post-operative morbidity and in hospital time.