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目的探讨腹腔镜肝切除治疗肝脏肿瘤的临床疗效及手术方法的可行性和优缺点。方法 2009年1月至2011年8月期间我科为32例肝脏肿瘤患者施行腹腔镜下肝脏切除治疗,对其临床资料进行回顾性总结分析。结果采用腹腔镜下解剖性肝脏切除29例,非解剖性肝脏切除3例,32例患者手术均获得成功,包括原发性肝癌23例,转移性肝癌5例,肝血管瘤3例,肝局灶性结节性增生1例。腹腔镜肝切除包括左外叶切除(Ⅱ+Ⅲ段)17例,左内叶切除(Ⅳ段)2例(左外叶已切除),左半肝切除(Ⅱ+Ⅲ+Ⅳ段)8例,Ⅴ段切除1例,Ⅵ段切除1例,Ⅲ、Ⅳ、Ⅴ段部分肝切除3例。肝切除手术时间75～285 min,平均215 min;术中出血115～760 ml,平均365 ml。未发生胆汁漏、出血、气体栓塞等并发症。术后1～3 d肛门排气、胃肠功能恢复后进食,5～11 d(平均6 d)恢复出院。随访31例,随访时间6～32个月,平均18个月,除1例术后1年因肿瘤复发转移死亡外,其余均健在,健在肿瘤患者未发现复发、转移。结论腹腔镜肝切除治疗肝脏肿瘤创伤小,痛苦少,康复快,能达到根治要求,安全、可行,临床疗效好。
Objective To investigate the clinical efficacy of laparoscopic hepatectomy in the treatment of liver tumors and the feasibility and advantages and disadvantages of surgical methods. Methods From January 2009 to August 2011, 32 patients with liver cancer underwent laparoscopic liver resection in our department. The clinical data of the patients were retrospectively analyzed. Results: Laparoscopic anatomical liver resection in 29 cases, non-anatomical liver resection in 3 cases, 32 patients were successful in surgery, including 23 cases of primary liver cancer, 5 cases of metastatic liver cancer, 3 cases of hepatic hemangioma, hepatic One case of focal nodular hyperplasia. Laparoscopic hepatectomy included 17 cases of left external lobectomy (Ⅱ + Ⅲ), 2 cases of left internal lobectomy (Ⅳ), left external lobectomy (Ⅱ + Ⅲ + Ⅳ) , Ⅴ segment excision in 1 case, Ⅵ segment excision in 1 case, Ⅲ, Ⅳ, Ⅴ partial hepatectomy in 3 cases. Hepatectomy operation time 75 ~ 285 min, an average of 215 min; intraoperative hemorrhage 115 ~ 760 ml, an average of 365 ml. No bile leakage, bleeding, gas embolism and other complications. Anus was evacuated 1 to 3 days after operation, and gastrointestinal function was restored. After 5 to 11 days (average 6 days), the patients were discharged. All patients were followed up for 31 cases. The follow-up time ranged from 6 months to 32 months (mean 18 months). All patients were alive and survived without tumor recurrence and metastasis except one patient died of tumor recurrence and metastasis one year after operation. Conclusions Laparoscopic hepatectomy is a safe, feasible and effective method for the treatment of liver tumors with less trauma, less pain and quick recovery.