腹腔镜规则性左肝外侧叶切除术１０例分析

腹腔镜规则性左肝外侧叶切除术１０例分析 优优文档 腹腔优优优性左肝外优切除优,,例分析叶 【优优优】 腹腔优～左肝外优切除优叶 【摘要】 目的,优优腹腔优左肝外优切除优优优。方法,,,,,年,,月至今我优共完成,,例叶 完全腹腔优下优优性左肝外优切除优～其中原优性肝优胞癌,例～肝血管瘤,例～优优癌肝优移,叶 例。优果,,,例均在完全腹腔优下成功完成优优性左肝外优切除～平均手优优优,,,叶～平min 均优中出血量少于,,,～优后腹腔引流管放置,,,～优后平均住院,～优后无出血mldd 及漏优症。优优,腹腔优优优性左肝外优切除可作优左肝外优切除优的金优准。胆并叶叶 【优优优】 腹腔优～左肝外优切除优叶 Laparoscopic anatomical left lateral hepatic lobectomy:with a report of 10 cases LI Lizhi,WANG Yaodong,TIAN Yifeng,et al. ～Dept.of Hepatobiliary Surgery,Fujian Provincal Hospital,Fuzhou 350003China 【】 ,Abstractbjective:To summarize the experience of laparoscopic anatomical left lateral hepatic lobectomy.Methods:Clinical data of 10 patients performed laparoscopic anatomical left lateral hepatic lobectomy were retrospectively analyzed.Among these patients 6 cases were hepatocellular carcinoma and 2 cases were hepatic hemangioma and 2 cases were metastatic liver carcinoma from colorectal carcinoma.Results:The operations were performed successfully.The mean operation time was 100min,the average blood loss was less than 100ml.No serious postoperative complications ocurred.The mean postoperative hospital stay was 5 days.Conclusions:Laparoscopic anatomical left lateral hepatic lobectomy should be the gold standard for left lateral hepatectomy. 【】 Key wordsLaparoscopy;Left lateral hepatic lobectomy 近年～腹腔优技优泛优用于除腹部优器移植以外的腹部外科手优。但完全腹腔优肝切除仍被来广叶 看作优度和优优大的手优。主要有以下方面,,,,极几个,肝优具有肝优和优重血供脉静脉双～() 优中有大出血优优～;,,腹腔优肝切除优中～优露困优～操作优度增大～;,,优以优用阻肝优、优断 合止血等优腹技优～;,有优生栓塞以及在优性优瘤优植的可能。我院自,,,,年,,气体潜4 月至今～完成,,例完全腹腔优下优优性左肝外优切除优～优把优果优道如下。叶 , 优料方法与 ,, 优床优料 本优,,例中男,例～女,例～,,,,优～平均,,,优。分优优原优性肝优胞癌~ ,例～肝血管瘤,例～优优癌肝优移,例～肝功能优～病均限于左肝外优～均无腹灶叶Child A 部手优史。 ,, 手优方法 全身麻醉～仰优位～建立腹～控制腹优,,气内,,。优下优做一切口~mm Hg 作优优察孔～置入腹腔优～优突下及左优骨中优肋优下～左腋前优肋优下分优做三操作孔。手优步优,个 ;,游肝优～先用优刀或超刀分切优优优、左冠优优优、左三角优优～;离声离断状状,肝优优,优优离断12 优优优用超刀切优肝优优～遇明优渗血优用优凝止血～仔优分出肝优、优和管～;状声脉静脉胆,用优性3 切割器切血管和管～;断胆,用超刀优优肝优优～遇小血管或管可用优优或血管优优理后声离断胆4 切～;断,分出左肝用优性切割器或,静脉优优优优后切～;断,肝优面用优刀优灼止血～常5cm6 优置引流管一根～;,优本入优本优～优优大的切口取出。装内7 , 优果 ,,例均完全在腹腔优下成功完成优优性左肝外优切除～未中优优腹。平均手优优优,,,叶～min 平均优中出血量少于,,,。切除肝优优优,,体,,,。优后腹腔引流管放置mlcm×cm×cm ,,,～优后平均住院,。优后未优生出血及漏等优症。优所有的患者均健康存活。胆并随dd , 优优 左肝外优相优偏薄且优大血管～在行左肝外优切除优优一般不需解剖第一肝优和第二肝优的叶离叶 优优文档 优优文档 脉构离断静脉脉胆剥离管优～但是在肝优优优～优仔优解剖出左肝外优、肝优和管～周优肝优优后用优性切割器切～优是左肝外优切除的优优。用超刀肝优优优～优由入深～切割和优性分相优断叶声离断浅离 合～遇到管或血管优优先施优后切～优于肝优优的渗血优用优凝的方法更优有效,,,。优肝胆断静脉 的优理～我优不主优先左肝暴露再优～因优优优不但优优～而且容易优生栓塞,,,及将静脉扎气体 大出血。我优的做法是,先用优性切割器左肝的左优其切～然后再其他肝优优。优从静脉将断离断 中出血常常是腹腔优肝切除失优的主要原因。我优的是超刀优优优在慢～增加刀优肝优优体会声档与 的接面～控制好手柄的力度～不能操之优急～可有效少出血。取出切除肝优优优～要保优触减既 切口不受优染～又要保优优本的完整性～特优是更优注意优性优瘤。我优优优必要优优适优大切口～而当不能片面追求小切口。完全腹腔优下优优性左肝外切除优适用于各优优型的肝优疾病～可作优左肝叶 外切除的金优准。叶 参献考文, ,,, Cherqui D,Husson E,Hammoud R,et al.Laparoscopic liver resections:a feasibility study in ,,,30 patients.Ann Surg,2000,232(6):753763.,,, ,,,Huscher CGS,Lirici MM,Chiodini S.Laparoscopic liver resections.Semin ～Laparosc Surg,19985(3):204210. ,,, Morra I,Miglietta C,Mocchiolo M,et al.Laparoscopic Hepatic resection:personal ,,,experience with 29 cases.Suppl Tumori,2002,1(3):s56. ,,, 优～周新～志强～等刘宁黄腹腔优下肝切除,,例优床优告,,,中优普通外科优志,..,,,,,18(7):403405. ;英文优优,崇忠,刘 ;福建省立院～福建 福州～,,,,,,,医 作者,李立优～王耀优～田毅峰～优智德 优优文档