中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2012年
6期
416-419
,共4页
蔡柳新%方哲平%程敏玲%杜学峰%李振宇%吕尚东
蔡柳新%方哲平%程敏玲%杜學峰%李振宇%呂尚東
채류신%방철평%정민령%두학봉%리진우%려상동
腹腔镜%肝切除%Glisson蒂%腹腔镜多功能手术解剖器
腹腔鏡%肝切除%Glisson蒂%腹腔鏡多功能手術解剖器
복강경%간절제%Glisson체%복강경다공능수술해부기
Laparoscope%Hepatectomy%Glisson pedicel%Laparoscopic Peng's multifunctional operative dissector
目的 探讨Glisson蒂横断式腹腔镜左肝外叶切除术的可行性与安全性.方法 显露肝圆韧带根部,自肝圆韧带根部左缘开始,采用腹腔镜多功能手术解剖器(LPMOD)整体解剖左肝外叶Glisson蒂,依次游离左肝外叶Glisson蒂至Ⅱ、Ⅲ段分支,予以夹闭、切断.离断Glisson蒂分支后,可见其支配区域因缺血而变暗,再切除其支配区域的肝组织.如此反复离断约4～6条左肝外叶Glisson蒂至Ⅱ、Ⅲ段分支,同时切断左肝静脉及其属支,完成Glisson蒂横断式腹腔镜左肝外叶切除术.结果 8例均成功完成Glisson蒂横断式腹腔镜左肝外叶切除术,无中转开腹.手术时间L10～190(151.0±35.4) min,其中解剖左肝外叶Glisson蒂分支及切肝时间为70～135(101.0±24.1)min,术中出血100～300(210.0±89.4)ml,均未输血.术后丙氨酸转氨酶(ALT)升高值35～102(75.4±26.5)U/L,恢复正常时间2～6(3.0±1.7)d,术后住院时间6～10(8.2±1.6)d,无并发症发生.结论 Glisson蒂横断式腹腔镜左肝外叶切除术是安全可行的.
目的 探討Glisson蒂橫斷式腹腔鏡左肝外葉切除術的可行性與安全性.方法 顯露肝圓韌帶根部,自肝圓韌帶根部左緣開始,採用腹腔鏡多功能手術解剖器(LPMOD)整體解剖左肝外葉Glisson蒂,依次遊離左肝外葉Glisson蒂至Ⅱ、Ⅲ段分支,予以夾閉、切斷.離斷Glisson蒂分支後,可見其支配區域因缺血而變暗,再切除其支配區域的肝組織.如此反複離斷約4～6條左肝外葉Glisson蒂至Ⅱ、Ⅲ段分支,同時切斷左肝靜脈及其屬支,完成Glisson蒂橫斷式腹腔鏡左肝外葉切除術.結果 8例均成功完成Glisson蒂橫斷式腹腔鏡左肝外葉切除術,無中轉開腹.手術時間L10～190(151.0±35.4) min,其中解剖左肝外葉Glisson蒂分支及切肝時間為70～135(101.0±24.1)min,術中齣血100～300(210.0±89.4)ml,均未輸血.術後丙氨痠轉氨酶(ALT)升高值35～102(75.4±26.5)U/L,恢複正常時間2～6(3.0±1.7)d,術後住院時間6～10(8.2±1.6)d,無併髮癥髮生.結論 Glisson蒂橫斷式腹腔鏡左肝外葉切除術是安全可行的.
목적 탐토Glisson체횡단식복강경좌간외협절제술적가행성여안전성.방법 현로간원인대근부,자간원인대근부좌연개시,채용복강경다공능수술해부기(LPMOD)정체해부좌간외협Glisson체,의차유리좌간외협Glisson체지Ⅱ、Ⅲ단분지,여이협폐、절단.리단Glisson체분지후,가견기지배구역인결혈이변암,재절제기지배구역적간조직.여차반복리단약4～6조좌간외협Glisson체지Ⅱ、Ⅲ단분지,동시절단좌간정맥급기속지,완성Glisson체횡단식복강경좌간외협절제술.결과 8례균성공완성Glisson체횡단식복강경좌간외협절제술,무중전개복.수술시간L10～190(151.0±35.4) min,기중해부좌간외협Glisson체분지급절간시간위70～135(101.0±24.1)min,술중출혈100～300(210.0±89.4)ml,균미수혈.술후병안산전안매(ALT)승고치35～102(75.4±26.5)U/L,회복정상시간2～6(3.0±1.7)d,술후주원시간6～10(8.2±1.6)d,무병발증발생.결론 Glisson체횡단식복강경좌간외협절제술시안전가행적.
Objective To study the safety and feasibility of laparoscopic left lateral sectionectomy using the Glissonian pedicel approach.Methods The root of the round ligament of the liver was exposed and the Glissonian pedicel of the left lateral section was dissected,starting from left and using the lapa roscopic Peng's multifunctional operative dissector (LPMOD).After the Glissonian pedicel of segment Ⅱ and Ⅲ was dissected,clipped and cut,the ischemic boundary showed up.The liver was transected at the boundary of the ischemic liver,and the left hepatic vein and its branches were cut. Resutts The surgery was successtully performed in 8 patients.There was no conversion to open operation.The operative time was 110- 190 (151.0±35.4) min.The time of Glissonian pedicel dissection and liver resection was 70- 135 (101.0±24.1) min.Operative blood loss was 100-300(210.0± 89.4) ml.The ALT increased by 35- 102 (75.4± 26.5) U/L after operation and decreased to a normal level in 2-6 (3.0± 1.7) d.The postoperative hospital stay was 6-10 (8.2± 1.6) d.There was no major complication.Conclusion Laparoscopic left lateral sectionectomy using the Glissonian pedicel approach is safe and feasible.
