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选择性肝血管阻断下腹腔镜肝切除及肝血管瘤剜除术:技术与适应证

Laparoscopic Liver Resection and Enucleation of Liver Hemangioma with Selective Hepatic Vascular Occlusion: Technique and Indications.

作者信息

Wang Youlong, Ji Wenbin, Zhang Xi, Tan Jingwang

机构信息

1 Academy of Military Medical Sciences, Graduate School , Beijing, China .

2 Chinese PLA General Hospital , Beijing, China .

出版信息

J Laparoendosc Adv Surg Tech A. 2017 Sep;27(9):944-950. doi: 10.1089/lap.2016.0432. Epub 2016 Oct 18.

Abstract

BACKGROUND

Liver resection or enucleation has been the basic treatment for liver hemangioma. However, there were few reports about laparoscopic surgery (LS) of hemangioma. The intention of this study is to explore the indication and efficacy of LS for laparoscopic hepatectomy (LH) and develop an opinion of these modern developments.

PATIENTS AND METHODS

Forty-four patients with LH underwent LS, with hemihepatic vascular occlusion (HVO group n = 24) or modified vascular occlusion (MVO group n = 20), and were retrospectively reviewed, including patients' demography, surgical technique, tumor size and location, blood loss, operation time, complications, modes of hepatic vascular occlusion and changes in postoperative liver function, and the difference in patients demography and operative outcome between HVO and MVO groups were compared as well.

RESULTS

There were no deaths. The mean operating time was 162 minutes, intraoperative blood loss was 335 mL, blood transfusion rate was 9.1%, postoperative complication rate was 18.2%, and length of hospital stay was 7.3 days. Although the tumor size in the HVO group was significantly larger than that in the MVO group, there were no differences concerning operating outcomes, length of stay, and postoperative serum alanine transaminase (ALT), aspertate aminotransferase (AST) level between the HVO and MVO groups.

CONCLUSIONS

LS was feasible for LH with hepatic vascular occlusion with zero mortality and low complication rate.

摘要

背景

肝切除术或肝血管瘤剜除术一直是肝血管瘤的基本治疗方法。然而,关于肝血管瘤腹腔镜手术(LS)的报道较少。本研究旨在探讨腹腔镜肝切除术(LH)中LS的适应证和疗效,并对这些现代进展形成观点。

患者与方法

对44例行LH的患者进行了LS,其中24例行半肝血管阻断(HVO组),20例行改良血管阻断(MVO组),回顾性分析患者的人口统计学资料、手术技术、肿瘤大小和位置、失血量、手术时间、并发症、肝血管阻断方式及术后肝功能变化,并比较HVO组和MVO组患者人口统计学和手术结果的差异。

结果

无死亡病例。平均手术时间为162分钟,术中失血量为335毫升,输血率为9.1%,术后并发症发生率为18.2%,住院时间为7.3天。虽然HVO组的肿瘤大小明显大于MVO组,但HVO组和MVO组在手术结果、住院时间及术后血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)水平方面无差异。

结论

对于行肝血管阻断的LH,LS是可行的,死亡率为零,并发症发生率低。

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