肝蒂优先路径腹腔镜解剖性肝Ⅷ段切除13例报道
Laparoscopic anatomical hepatectomy for segment Ⅷ using hepatic pedicle-first approach:13 cases report
魏勇 1牛洪凯 1马维杰 1成雨1
作者信息
- 1. 滨州医学院烟台附属医院肝胆胰脾外科,烟台 264100
- 折叠
摘要
目的 探讨肝蒂优先路径腹腔镜解剖性肝Ⅷ段切除术的可行性及安全性.方法 回顾性分析2021年1月至2023年5月在滨州医学院烟台附属医院行肝蒂优先路径腹腔镜解剖性肝Ⅷ段切除的13例肝细胞癌患者的临床资料,其中男性10例,女性3例,年龄(65±8)岁,年龄范围为52～77岁.术中首先解剖第一肝门,处理Ⅷ段肝蒂,获得肝Ⅷ段缺血范围,根据缺血边界离断肝实质.记录患者的手术方式、手术时间、术中出血量、术后住院时间以及术后并发症.结果 13例患者均顺利完成肝蒂优先腹腔镜解剖性肝Ⅷ段切除术,无中转开腹.5例患者Ⅷ段肝蒂从肝门附近的右前Glisson蒂分叉,其余患者Ⅷ段肝蒂位置较深,需离断肝门部分肝组织显露.手术时间为(295.3± 47.1)min,术中出血量为100.0(60.0,200.0)ml,无术中输血,术后住院时间(7.1±1.2)d.13例患者中1例发生术后胆漏,引流7 d后自愈.结论 肝蒂优先路径腹腔镜解剖性Ⅷ段切除安全可行,尤其适用于Ⅷ段肝蒂近肝门处起源于右前肝蒂的患者.
Abstract
Objective To assess the safety and feasibility of laparoscopic anatomical hepatectomy for segment Ⅷ using hepatic pedicle-first approach.Methods Thirteen patients with hepatocellular carci-noma undergoing laparoscopic anatomical hepatic segment Ⅷ resection at the Yantai Affiliated Hospital of Binzhou Medical University from January 2021 to May 2023 were enrolled,including 10 males and 3 females,aged(65±8)years old.During the operation,the hilar region was dissected to occlude the seg-mentⅧpedicle,the liver ischemic demarcation was obtained,and the liver parenchyma was transected trac-ing ischemic boundary.The methods of operation,operative time,intraoperative blood loss,postoperative complications and hospital-stay were retrospectively analyzed.Results Laparoscopic anatomical hepatic segment Ⅷ resection was successfully performed in 13 patients without conversion to laparotomy.Among them,the segment Ⅷ pedicle in five patients bifurcated from the right anterior Glisson pedicle near hilar region,while in other cases,segment Ⅷ pedicle originated in a deeper position,requiring partial transection of liver parenchyma.The operative time,intraoperative blood loss and postoperative hospital stay was(295.3±47.1)min,100.0(60.0,200.0)ml,and(7.1±1.2)d respectively.There was no intraopera-tive blood transfusion.One patient had postoperative biliary leakage,which was managed by drainage for 7 days,and other patients recovered uneventfully.Conclusion It is safe and feasible to perform laparoscopic anatomical segment Ⅷ resection using hepatic pedicle-first approach,which could be suitable for cases with segment Ⅷ pedicle originated from right anterior liver pedicle near hilar region.
关键词
癌,肝细胞/解剖性肝切除/肝Ⅷ段/腹腔镜Key words
Carcinoma,hepatocellular/Anatomical hepatectomy/Liver segment Ⅷ/Laparo-scope引用本文复制引用
出版年
2024
NETL
NSTL
万方数据