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目的探讨腹腔镜左肝外叶切除术操作要点及解剖基础。方法选取2014年4—12月于景德镇市第一人民医院行腹腔镜左肝外叶切除术的肝脏疾病患者10例,术后查阅文献并结合手术经验总结腹腔镜肝左外叶切除术的操作要点与解剖注意事项。结果患者左肝外叶静脉均为Ⅲ段属支,其中单支型7例,双支型3例;属支距切断面前缘0.6~1.7cm,平均(1.2±0.3)cm;属支距膈面0.5~1.7cm,平均(1.2±0.2)cm;均顺利完成手术;手术时间166~254min,平均(195.5±13.8)min;术中出血量105~208ml,平均(108.2±20.2)ml;术后拔除腹腔引流管时间2~6d,平均(3.3±0.5)d;住院时间5~15d,平均(8.5±2.2)d;患者术后均未发生严重并发症。结论充分掌握手术操作要点并明确左肝外叶解剖方法后,腹腔镜左肝外叶切除术可推广至各阶层医院应用。
Objective To investigate the main points of operation and anatomy of laparoscopic left extrahepatic lobectomy. Methods From April to December 2014, 10 patients with liver disease undergoing laparoscopic left hepatic resection in First People’s Hospital of Jingdezhen City were enrolled. After operation, the literature and combined with surgical experience were summarized laparoscopic operation of left hepatic lobectomy Essentials and anatomical considerations. Results The left extrahepatic veins of the patients were all in section Ⅲ, of which 7 cases were single type and 3 cases were double type. The frontal margin of the cut off was 0.6-1.7 cm with an average of (1.2 ± 0.3) cm. The average operation time was 166-254 minutes (mean, 195.5 ± 13.8) minutes. The intraoperative blood loss was 105-208 ml, with an average of (108.2 ± 20.2) After removal of the abdominal drainage tube time 2 ~ 6d, an average of (3.3 ± 0.5) d; hospitalization 5 ~ 15d, an average of (8.5 ± 2.2) d; no serious postoperative complications. Conclusion To fully grasp the main points of surgical operation and clear the method of left extrahepatic lobe dissection, laparoscopic left hepatic resection can be extended to all levels of hospital application.