CAJ | 학술논문

目的：探讨完全腹腔镜肝Ⅶ段肿瘤手术切除的可行性、安全性和手术技巧。方法回顾性分析2013年6月－2014年3月期间我院行完全腹腔镜下肝Ⅶ肿瘤切除10例患者的临床资料，其中原发性肝细胞癌8例、结肠癌肝转移1例、肝局灶性结节增生1例。术前均进行肝功能评估、CT三维血管成像确定肿瘤肝段位置及周围重要血管情况并进行手术规划，术中均采用超声刀、钛夹或Hem-o-lok 等断肝。结果10例患者均成功实施完全腹腔镜下肝Ⅶ段肿瘤切除术，手术时间105～215 min，失血量50～500 ml，术中未出现严重并发症，术后均康复出院，术后平均住院时间7．0 d。术后随访除1例原发性肝癌破裂患者术后约2月腹膜转移外，其余9例均未见复发。结论术前全面评估及手术规划、术中充分游离暴露肝脏肿瘤及腹腔镜下精准断肝技术是成功施行完全腹腔镜肝Ⅶ段切除术的重要保证。
목적：탐토완전복강경간Ⅶ단종류수술절제적가행성、안전성화수술기교。방법회고성분석2013년6월－2014년3월기간아원행완전복강경하간Ⅶ종류절제10례환자적림상자료，기중원발성간세포암8례、결장암간전이1례、간국조성결절증생1례。술전균진행간공능평고、CT삼유혈관성상학정종류간단위치급주위중요혈관정황병진행수술규화，술중균채용초성도、태협혹Hem-o-lok 등단간。결과10례환자균성공실시완전복강경하간Ⅶ단종류절제술，수술시간105～215 min，실혈량50～500 ml，술중미출현엄중병발증，술후균강복출원，술후평균주원시간7．0 d。술후수방제1례원발성간암파렬환자술후약2월복막전이외，기여9례균미견복발。결론술전전면평고급수술규화、술중충분유리폭로간장종류급복강경하정준단간기술시성공시행완전복강경간Ⅶ단절제술적중요보증。
Objective To investigate the feasibility and safety of total laparoscopic partial liver resection for tumor originated from segment Ⅶ and introduce the surgical technique.Methods From Jun. 2013 to Mar.2014,10 cases of laparoscopic partial liver resection for tumor originated from segment Ⅶ in our hospital were analyzed retrospectively,including 8 cases of hepatocellular carcinoma,1 case of liver metastasis from colon cancer and 1 case of focal nodular hyperplasia.Child Classification and ICG R15 were used to evaluate hepatic reservation function preoperatively and three-dimensional CT imaging was used to assess the anatomical structure surrounding liver tumor such as blood vessels,intraoperative surgical approach is selected according to the liver lesion site and using ultrasonic knives,clips,Hem-o-lok and other laparoscopic equipments to dissect liver and complete partial liver resection.Results Total laparoscopic partial liver resection was carried successfully on 10 cases,with operative time between 105 to 215 minutes, blood loss between 50 to 500 ml. All patients recovered from the operation successfully with no complications.The average hospital stay postoperation was 7.0 d.Except one case of primary liver cancer with tumor rupture before operation were found to have peritonaeum metastasis about 2 months follow-up after operation,the rest has been found no evidence of tumor recurrence as yet.Conclusion Preoperative assessment of liver function and CT imaging,intraoperative adequate dissection and skilled application of the laparoscopic precise hepatectomy are the essential for successful and safe completion of laparoscopic partial liver resection for tumor originated from segment Ⅶ.