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目的探讨腹腔镜肝癌切除的安全性、可行性和微创性。方法回顾性分析2008年10月—2011年2月行腹腔镜肝癌切除术32例原发性肝癌患者的临床资料。结果 32例患者腹腔镜下肝癌切除术成功,无中转开腹。病灶分别位于Ⅱ段(3例),Ⅲ段(8例),Ⅱ+Ⅲ段(10例),IV段(2例),V段(4例),VI段(5例)。病灶直径1.8～9.2 cm,平均4.3 cm,均为单病灶,均合并肝硬化。术前肝功能Child A级者27例,Child B级5例。术式包括:左半肝切除2例,左外叶切除15例,局部切除15例。术中采用结合超声刀和LigaSure或内镜下切割缝合器(Endo-GIA)联合断肝。2例患者临时阻断第一肝门,时间分别为15,22 min,3例患者术中输红细胞2 U。术后无创面出血及胆瘘等并发症,无肝功能衰竭发生,均痊愈出院。32例随访5～26个月,3例局部复发,无死亡病例。结论腹腔镜肝癌切除是安全、可行的,腹腔镜肝癌切除技术难度大,手术适应证应严格选择,病灶大小和位置是主要的参考指标;超声刀与Ligasure联合断肝止血效果好、解剖结构清晰。
Objective To investigate the safety, feasibility and minimally invasive surgical resection of laparoscopic liver cancer. Methods The clinical data of 32 patients with primary liver cancer who underwent laparoscopic liver cancer resection from October 2008 to February 2011 were retrospectively analyzed. Results 32 cases of laparoscopic resection of liver cancer was successful, no laparotomy. The lesions were located in segment Ⅱ (3 cases), segment Ⅲ (8 cases), segment Ⅱ + Ⅲ (10 cases), segment IV (2 cases), segment V (4 cases) and segment VI (5 cases). Lesion diameter 1.8 ~ 9.2 cm, an average of 4.3 cm, are single lesions, were associated with cirrhosis. Preoperative liver function Child A class in 27 cases, Child B class in 5 cases. Procedures include: left hepatic resection in 2 cases, left external resection in 15 cases, partial resection in 15 cases. Intraoperative use of ultrasonic scalpel and LigaSure or endoscopic cutting stapler (Endo-GIA) combined with broken liver. Two patients temporarily blocked the first portal, the time was 15,22 min, 3 patients were transfused 2 U red blood cells. No postoperative bleeding and complications such as biliary fistula, no liver failure occurred, were cured and discharged. 32 cases were followed up for 5 to 26 months, 3 cases of local recurrence, no deaths. Conclusion laparoscopic resection of liver cancer is safe and feasible, laparoscopic resection of liver cancer is difficult, the surgical indications should be strictly selected, the size and location of the lesion is the main reference index; ultrasonic knife and Ligasure joint liver breaking hemostatic effect is good, clear anatomy .