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目的探讨手助腹腔镜左肝巨大肝肿瘤切除的可行性和安全性。方法本组9例患者,平均年龄45.3岁,肿瘤均位于左肝,包括肝细胞癌(4例),肝内胆管细胞癌(1例),肝转移性鳞癌(1例),肝海绵状血管瘤(2例),肝梭形细胞瘤(1例)。AFP 阳性3例,CEA 阳性1例,术前肝功能均为 Child-Pugh A 级,手术按游离左肝韧带、阻断肝门和肝实质切除的步骤进行。结果 9例手助腹腔镜肝切除均获得成功,肝左外叶切除6例,左半肝切除3例,无中转开腹。平均手术时间为111.7 min,平均出血量97.8 ml,8例行肝门阻断,平均阻断时间为13.4 min。术中未发生大出血和气体栓塞,术后均无出血、胆漏和肝衰竭等严重并发症发生。肝功能均在7～10 d 恢复正常。AFP 和CEA 阳性者均转阴,术后平均住院日为8.4 d。4例肝细胞癌术后1个月行预防性肝动脉造影和化疗1次。术后随访4～11个月,所有患者均无瘤生存。结论只要病例选择得当,手助腹腔镜左肝巨大肝肿瘤切除是安全可行的微创手术方式。
Objective To investigate the feasibility and safety of hand-assisted laparoscopic surgery for left hepatic giant liver tumor. Methods Nine patients in this study, with an average age of 45.3 years, were all located in the left liver, including hepatocellular carcinoma (4 cases), intrahepatic cholangiocarcinoma (1 case), liver metastatic squamous cell carcinoma (1 case), hepatomegaly Hemangioma (2 cases), hepatic spindle cell tumor (1 case). AFP-positive in 3 cases, CEA-positive in 1 case, preoperative liver function are Child-Pugh A-class surgery by free left hepatic ligament, blocking the hilar and liver resection steps. Results 9 cases of hand-assisted laparoscopic hepatectomy were successful, 6 cases of left hepatic resection and 3 cases of left hepatic resection without conversion to laparotomy. The average operation time was 111.7 min, the average amount of bleeding was 97.8 ml, and hepatic portal vein occlusion was performed in 8 patients with an average of 13.4 min. No intraoperative bleeding and gas embolism, no postoperative bleeding, biliary leakage and liver failure and other serious complications. Liver function returned to normal in 7 ~ 10 days. AFP and CEA positive were negative, the average postoperative hospital stay was 8.4 d. 4 cases of hepatocellular carcinoma one month after surgery preventive hepatic artery angiography and chemotherapy 1 times. All cases were followed up for 4 to 11 months without any tumor. Conclusion As long as the case is properly selected, hand-assisted laparoscopic surgery for left hepatic giant hepatic tumor resection is a safe and feasible minimally invasive surgical approach.