CAJ | 학술논문

目的探讨腹腔镜肝切除术的应用指征、技术要点和疗效.方法回顾分析本研究所463例腹腔镜肝切除术患者的临床资料和随访结果.结果2007年3月1日至2011年3月31日共完成各类腹腔镜肝切除手术463例.其中原发性肝癌165例,转移性肝癌29例,肝血管瘤143例,肝胆管结石病81例,其他肝脏良性占位病变(肝血管平滑肌脂肪瘤、肝细胞腺瘤、局灶性结节增生、慢性肝脓肿等)45例.手术方式包括腹腔镜下左肝外叶切除术93例,左半肝切除71例,超左半肝切除4例,右半肝切除29例,右肝后叶切除24例,Ⅵ段切除56例,超右半肝切除2例,中肝切除8例,特殊部位肝段切除(Ⅶ/Ⅷ段、Ⅳa、尾叶及Ⅵ段、Ⅶ段交界处)41例,病变局部不规则性切除121例,两个以上部位联合切除14例.手术时间(244.71±105.07)min,术中出血量(460.26±425.81)ml,无手术死亡,术后并发症发生率9.29%,平均住院时间(15.51±4.36)d.194例肝脏恶性肿瘤患者中185例获得2～50个月随访,术后1年、3年总体生存率为90.8%和84.2%,无瘤生存率为87.9%和73.7%.结论腹腔镜肝切除术作为一种微创治疗手段,可选择性应用于肝脏各个部位、各类病变的手术治疗.该法且具有创伤小、恢复快、切口美容的优点.其近期疗效优于开腹手术,远期疗效与开腹手术相当.肝脏良性病变、小肝癌和转移性肝癌是现阶段腹腔镜肝切除术较理想的适应证.
목적탐토복강경간절제술적응용지정、기술요점화료효.방법회고분석본연구소463례복강경간절제술환자적림상자료화수방결과.결과2007년3월1일지2011년3월31일공완성각류복강경간절제수술463례.기중원발성간암165례,전이성간암29례,간혈관류143례,간담관결석병81례,기타간장량성점위병변(간혈관평활기지방류、간세포선류、국조성결절증생、만성간농종등)45례.수술방식포괄복강경하좌간외협절제술93례,좌반간절제71례,초좌반간절제4례,우반간절제29례,우간후협절제24례,Ⅵ단절제56례,초우반간절제2례,중간절제8례,특수부위간단절제(Ⅶ/Ⅷ단、Ⅳa、미협급Ⅵ단、Ⅶ단교계처)41례,병변국부불규칙성절제121례,량개이상부위연합절제14례.수술시간(244.71±105.07)min,술중출혈량(460.26±425.81)ml,무수술사망,술후병발증발생솔9.29%,평균주원시간(15.51±4.36)d.194례간장악성종류환자중185례획득2～50개월수방,술후1년、3년총체생존솔위90.8%화84.2%,무류생존솔위87.9%화73.7%.결론복강경간절제술작위일충미창치료수단,가선택성응용우간장각개부위、각류병변적수술치료.해법차구유창상소、회복쾌、절구미용적우점.기근기료효우우개복수술,원기료효여개복수술상당.간장량성병변、소간암화전이성간암시현계단복강경간절제술교이상적괄응증.
Objective To investigate the indications, techniques and results of laparoscopic hepatectomy. Methods The clinical data and follow-up results of 463 patients who received laparoscopic hepatectomy at our institute were retrospectively analyzed. Results From March 1, 2007 to March 31, 2011, 463 cases of laparoscopic hepatectomy were successfully carried out. Of the 463 patients,165 were with primary liver cancer, 29 with metastatic liver cancer, 143 with hepatic hemangioma, 81with hepatolithiasis and 45 with other benign liver diseases (including hepatic angiomyolipoma, hepatocellular adenoma, focal nodular hyperplasia and chronic liver abscess). The surgical approaches included laparoscopic left lateral lobectomy (93 cases), left hepatectomy (71 cases), extended left hepatectomy (4 cases), right hepatectomy (29 cases), right posterior lobectomy (24 cases), hepatectomy of segment Ⅵ (56 cases), extended right hepatectomy (2 cases), central hepatectomy (8 cases) and hepatectomy of segments Ⅶ/Ⅷ, Ⅳa, caudate lobe and the junction of segment Ⅵ and Ⅶ (41 case).Nonanntomic and wedge resection were performed on 121 patients, and combined resection on 14 patients. The mean operation time, blood loss, length of hospital stay and incidence of postoperative complications were (244.71 ± 105. 07) minutes, (460. 26±425.81) ml, (15.51 ±4.36) days and 9.29%, respectively. And no operative death occurred. In the 194 cases with malignant liver lesions,185 cases were followed up for 2 to 50 months. The 1 year and 3 year overall and disease free survival rate were 90. 8% and 87.9% , 84.2% and 73. 7% respectively. Conclusions As a means of minimally invasive surgical approach, laparoscopic hepatectomy can be selectively adopted for the treatment of all kinds of liver diseases which located at different parts of the liver, with the advantages of smaller trauma, quick recovery and cosmetic benefits. The short-term results of laparoscopic hepatectomy is superior to and its long-term results is equal to that of open surgery. Benign liver diseases, small hepatocellular carcinoma and metastatic liver cancer are the good indications for laparoscopic hepatectomy.