中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2015年
4期
305-309
,共5页
肝肿瘤%肝胆管结石病%腹腔镜检查%肝切除术%Glisson蒂
肝腫瘤%肝膽管結石病%腹腔鏡檢查%肝切除術%Glisson蒂
간종류%간담관결석병%복강경검사%간절제술%Glisson체
Liver neoplasms%Hepatolithiasis%Laparoscopy%Hepatectomy%Glissonean pedicle
目的 探讨Glisson蒂横断式腹腔镜解剖性肝切除术的临床疗效.方法 回顾性分析2009年3月至2013年12月第三军医大学西南医院收治的68例行Glisson蒂横断式腹腔镜解剖性肝切除术患者的临床资料.采用全身麻醉,腹腔镜下根据肝蒂走行的解剖学标记,完整分离并阻断Glisson蒂内的门静脉三联结构,以不解剖Glisson蒂内的管道结构的方式分离Glisson蒂后再离断肝实质.肝胆管结石病患者根据合并肝外胆道病变情况行术中胆道镜探查和(或)取石,并放置T管.肝脏良性病变标本破碎后经腹部12 mm Trocar孔取出;肝脏恶性肿瘤标本,经腹上区Trocar孔扩大切口或者耻骨联合上横切口完整取出.采用电话和门诊随访,根据患者疾病的良恶性复查相关指标,随访时间截至2014年9月.符合正态分布的计量资料以(x)±s表示,采用Kaplan-Meier法绘制生存曲线.结果 68例患者中,64例完成Glisson蒂横断式腹腔镜解剖性肝切除术,4例中转开腹.68例患者的手术方式分别为解剖性左半肝切除术30例,解剖性右半肝切除术19例,解剖性肝右后叶切除术10例,解剖性肝右前叶切除术9例.68例患者手术时间为(224±117) min,术中出血量为(413±349) mL,围术期输血率为5.9％ (4/68),术后胃肠道功能恢复时间为(3.0±0.5)d,术后住院时间为(8.0±3.0)d.无围术期死亡患者,6例患者术后发生并发症,经对症支持治疗后痊愈.29例肝脏恶性肿瘤患者肿瘤直径为(4.4±1.6)cm,切缘距肿瘤距离为(2.0±0.9)cm.病理学诊断:肝胆管结石病22例,肝海绵状血管瘤12例,肝脏局灶性结节状增生1例,肝脏腺瘤1例,肝脏血管平滑肌脂肪瘤1例,肝脏多发囊肿1例,肝结核1例,肝细胞癌27例,胆管细胞癌2例.68例患者均获得随访,随访时间为6 ～ 60个月,平均随访时间为24个月.39例肝脏良性疾病患者随访期间未出现结石或病灶残留及复发;29例肝脏恶性肿瘤患者术后1、3、5年总体生存率分别为92％、84％、60％,无瘤生存率分别为83％、59％、42％.结论 Glisson蒂横断式腹腔镜解剖性肝切除术安全、可行,不仅适用于左半肝切除术,也适用于技术要求相对较高的右半肝切除术.
目的 探討Glisson蒂橫斷式腹腔鏡解剖性肝切除術的臨床療效.方法 迴顧性分析2009年3月至2013年12月第三軍醫大學西南醫院收治的68例行Glisson蒂橫斷式腹腔鏡解剖性肝切除術患者的臨床資料.採用全身痳醉,腹腔鏡下根據肝蒂走行的解剖學標記,完整分離併阻斷Glisson蒂內的門靜脈三聯結構,以不解剖Glisson蒂內的管道結構的方式分離Glisson蒂後再離斷肝實質.肝膽管結石病患者根據閤併肝外膽道病變情況行術中膽道鏡探查和(或)取石,併放置T管.肝髒良性病變標本破碎後經腹部12 mm Trocar孔取齣;肝髒噁性腫瘤標本,經腹上區Trocar孔擴大切口或者恥骨聯閤上橫切口完整取齣.採用電話和門診隨訪,根據患者疾病的良噁性複查相關指標,隨訪時間截至2014年9月.符閤正態分佈的計量資料以(x)±s錶示,採用Kaplan-Meier法繪製生存麯線.結果 68例患者中,64例完成Glisson蒂橫斷式腹腔鏡解剖性肝切除術,4例中轉開腹.68例患者的手術方式分彆為解剖性左半肝切除術30例,解剖性右半肝切除術19例,解剖性肝右後葉切除術10例,解剖性肝右前葉切除術9例.68例患者手術時間為(224±117) min,術中齣血量為(413±349) mL,圍術期輸血率為5.9％ (4/68),術後胃腸道功能恢複時間為(3.0±0.5)d,術後住院時間為(8.0±3.0)d.無圍術期死亡患者,6例患者術後髮生併髮癥,經對癥支持治療後痊愈.29例肝髒噁性腫瘤患者腫瘤直徑為(4.4±1.6)cm,切緣距腫瘤距離為(2.0±0.9)cm.病理學診斷:肝膽管結石病22例,肝海綿狀血管瘤12例,肝髒跼竈性結節狀增生1例,肝髒腺瘤1例,肝髒血管平滑肌脂肪瘤1例,肝髒多髮囊腫1例,肝結覈1例,肝細胞癌27例,膽管細胞癌2例.68例患者均穫得隨訪,隨訪時間為6 ～ 60箇月,平均隨訪時間為24箇月.39例肝髒良性疾病患者隨訪期間未齣現結石或病竈殘留及複髮;29例肝髒噁性腫瘤患者術後1、3、5年總體生存率分彆為92％、84％、60％,無瘤生存率分彆為83％、59％、42％.結論 Glisson蒂橫斷式腹腔鏡解剖性肝切除術安全、可行,不僅適用于左半肝切除術,也適用于技術要求相對較高的右半肝切除術.
목적 탐토Glisson체횡단식복강경해부성간절제술적림상료효.방법 회고성분석2009년3월지2013년12월제삼군의대학서남의원수치적68례행Glisson체횡단식복강경해부성간절제술환자적림상자료.채용전신마취,복강경하근거간체주행적해부학표기,완정분리병조단Glisson체내적문정맥삼련결구,이불해부Glisson체내적관도결구적방식분리Glisson체후재리단간실질.간담관결석병환자근거합병간외담도병변정황행술중담도경탐사화(혹)취석,병방치T관.간장량성병변표본파쇄후경복부12 mm Trocar공취출;간장악성종류표본,경복상구Trocar공확대절구혹자치골연합상횡절구완정취출.채용전화화문진수방,근거환자질병적량악성복사상관지표,수방시간절지2014년9월.부합정태분포적계량자료이(x)±s표시,채용Kaplan-Meier법회제생존곡선.결과 68례환자중,64례완성Glisson체횡단식복강경해부성간절제술,4례중전개복.68례환자적수술방식분별위해부성좌반간절제술30례,해부성우반간절제술19례,해부성간우후협절제술10례,해부성간우전협절제술9례.68례환자수술시간위(224±117) min,술중출혈량위(413±349) mL,위술기수혈솔위5.9％ (4/68),술후위장도공능회복시간위(3.0±0.5)d,술후주원시간위(8.0±3.0)d.무위술기사망환자,6례환자술후발생병발증,경대증지지치료후전유.29례간장악성종류환자종류직경위(4.4±1.6)cm,절연거종류거리위(2.0±0.9)cm.병이학진단:간담관결석병22례,간해면상혈관류12례,간장국조성결절상증생1례,간장선류1례,간장혈관평활기지방류1례,간장다발낭종1례,간결핵1례,간세포암27례,담관세포암2례.68례환자균획득수방,수방시간위6 ～ 60개월,평균수방시간위24개월.39례간장량성질병환자수방기간미출현결석혹병조잔류급복발;29례간장악성종류환자술후1、3、5년총체생존솔분별위92％、84％、60％,무류생존솔분별위83％、59％、42％.결론 Glisson체횡단식복강경해부성간절제술안전、가행,불부괄용우좌반간절제술,야괄용우기술요구상대교고적우반간절제술.
Objective To investigate the clinical efficacy of laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach.Methods The clinical data of 68 patients who underwent laparoscopic anatomical hepatectomy by Glissonean pedicle transection approach at the Southwest Hospital of Third Military Medical University between March 2009 and December 2013 were retrospectively analyzed.All the patients received intravenous-inhalation general anesthesia.The splitting of liver was carried out after Glissonean pedicles were completely dissected and occluded under the laparoscope according to anatomical structure.The patients with hepatolithiasis underwent intraoperative bile duct exploration and stone removal with T-tube placement based on the conditions of extrahepatic biliary lesions.The fragmented specimens from benign lesions of liver were taken out through a Trocar hole with the diameter of 12mm.The complete specimens from malignancy tumors of liver were taken out through an enlarged Trocar hole or transverse incision at the symphysis pubis.According to the recheck results of benign and malignancy lesions,the patients were followed up by outpatient examination and telephone interview till September 2014.The measurement data with normal distribution were presented as (x) ± s.The survival curve was drawn by Kaplan-Meier method.Results Among the 68 patients,laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach was performed on 64 patients and 4 patients were coverted to open surgery.Laparoscopic anatomical left hemihepatectomy was performed on 30 patients,anatomical right hemihepatectomy on 19 patients,anatomical right posterior lobectomy on 10 patients and anatomical right anterior lobectomy on 9 patients.The mean operation time,volume of intraoperative blood loss,rate of perioperative blood transfusion,time of postoperative gastrointestinal function recovery and duration of hospital stay were (224 ± 117)minutes,(413 ± 349) mL,5.9％ (4/68),(3.0 ± 0.5) days and (8.0 ± 3.0) days,respectively.There was no perioperative death,and 6 patients with postoperative complication were cured by symptomatic treatment.The tumor diameter and distance to resection margin in 29 patients with malignancy tumors of liver were (4.4 ± 1.6) cm and (2.0 ± 0.9)cm,respectively.The results of pathological examination showed that hepatolithiasis was detected in 22 patients,cavernous hemangioma of liver in 12 patients,hepatic focal nodular hyperplasia in 1 patient,hepatic adenoma in 1 patient,hepatic angiomyolipoma in 1 patient,hepatic multiple cysts in 1 patient,hepatic tuberculosis in 1 patient,hepatocellular carcinoma in 27 patients and cholangiocarcinoma in 2 patients.All the 68 patients were followed up for 6-60 months with a mean time of 24 months.No recurrence and residual stones or lesions in 39 patients with benign lesions of liver were detected during the follow-up.The 1-,3-,5-year overall survival rates and tumor-free survival rates in 29 patients with malignant tumors of liver were 92％,84％,60％ and 83％,59％,42％,respectively.Conclnsion Laparoscopic anatomical hepatectomy via Glissonean pedicle transection approach is safe and feasible,and is suitable not only for left hemihepatectomy,but also for right hemihepatectomy of high technical specification.
