腹腔鏡肝尾狀葉腫瘤切除術(shù)9例臨床分析
發(fā)布時間：2018-08-09 10:39
【摘要】：研究背景:肝尾狀葉位于肝臟后部中央的位置,其局部解剖復雜,該處病變的手術(shù)治療一直是肝膽外科的難點,隨著研究的深入,尾狀葉腫瘤手術(shù)治療的病例報道逐漸增多,其治療策略已逐漸達成共識。如今腹腔鏡手術(shù)技術(shù)因其創(chuàng)傷小、切口愈合美觀、患者術(shù)后恢復快、并發(fā)癥少等諸多優(yōu)點在臨床上得到廣泛運用,然而目前腹腔鏡尾狀葉腫瘤切除的病例報道非常少,其手術(shù)治療經(jīng)驗匱乏尚未形成規(guī)范。本文將對腹腔鏡尾狀葉腫瘤切除術(shù)進行探討,總結(jié)經(jīng)驗,以指導日后臨床工作。目的:探討腹腔鏡尾狀葉腫瘤切除術(shù)的術(shù)前診斷、手術(shù)入路、手術(shù)方式、手術(shù)經(jīng)驗及安全性、可行性。方法:2015年6月至2016年12月間,山東大學齊魯醫(yī)院開展腹腔鏡肝尾狀葉腫瘤切除術(shù)9例,從術(shù)前診斷、手術(shù)入路、手術(shù)方式、術(shù)后恢復等方面對臨床資料進行分析。結(jié)果:9例均由肝臟外科高級職稱醫(yī)師主刀,手術(shù)均順利完成,將腫物完全切除,均未中轉(zhuǎn)開腹。手術(shù)時間75min-285min,平均127.2min。術(shù)中失血量為50mL-350mL,平均失血量為133.3mL,術(shù)中均未輸血。9例手術(shù)中4例于第一肝門處預置阻斷帶,其中3例分別阻斷時間為21min、20min、15min。9例病例的入路選擇,其中2例為右側(cè)入路,4例選擇左右聯(lián)合入路,3例選擇左側(cè)入路。術(shù)中未損傷第一肝門、第二肝門、下腔靜脈,未出現(xiàn)大出血等并發(fā)癥。術(shù)后病理為4例為中分化肝細胞肝癌,4例為肝海綿狀血管瘤,1例為肝局灶性結(jié)節(jié)狀增生。9例患者術(shù)后住院時間6天-14天,平均住院天數(shù)8.2天。1例原發(fā)性肝癌患者術(shù)后腹腔引流管出現(xiàn)黃綠色膽汁楊液體,考慮為手術(shù)創(chuàng)面存在膽漏,給予持續(xù)腹腔引流,帶管出院后近2月后痊愈。其余患者術(shù)后病情較平穩(wěn),無嚴重并發(fā)癥,給予抗炎、保肝、抑酸、營養(yǎng)支持治療,恢復良好后出院�；颊咦≡嘿M用為38241.35 元-82452 元,平均費用 55464.83 元。結(jié)論:肝尾狀葉腫瘤一般表現(xiàn)為上腹或右上腹痛、腹脹,進食后飽脹不適,部分患者可無癥狀,由查體時發(fā)現(xiàn)。B超、腹部CT、MRI等影響學檢查對于尾狀葉腫瘤的術(shù)前診斷及手術(shù)方式的選擇具有重要意義。因尾狀葉位置特殊,周圍解剖關(guān)系復雜,行腹腔鏡尾狀葉腫瘤切除時,應根據(jù)腫瘤所在的部位、大小及與周圍其他肝段或血管關(guān)系,可采用合適的入路及手術(shù)方式,通常尾狀葉右部的腫瘤,采用右側(cè)或左右聯(lián)合入路,尾狀葉左部腫瘤可以選擇左側(cè)入路或左右聯(lián)合入路,左右聯(lián)合入路是目前臨床應用最多手術(shù)入路。腹腔鏡尾狀葉腫瘤切除術(shù)適用于尾狀葉病灶較小并局限于尾狀葉的腫瘤,若腫瘤瘤體巨大,侵犯其它肝段,或其它肝段存在腫瘤時應選擇聯(lián)合其它肝葉或肝段切除。手術(shù)中應在仔細探查尾狀葉與下腔靜脈的間隙,將肝短靜脈逐一夾閉并切斷。第一肝門、第二肝門處的重要血管應避免損傷,可于第一肝門預置阻斷帶,在手術(shù)出血較多的情況下進行肝門阻斷。手術(shù)前對患者進行充分檢查并評估患者病情,由高年資經(jīng)驗豐富的外科醫(yī)師手術(shù),腹腔鏡肝尾狀葉腫瘤切除術(shù)雖然手術(shù)過程較復雜,但是安全、可行的,且治療效果良好。
[Abstract]:Background: the liver caudate lobe is located in the central position of the posterior part of the liver, and its local anatomy is complicated. The surgical treatment of the lesion is always the difficult point in the Department of hepatobiliary surgery. With the further research, the cases of caudate tumor surgery are gradually increasing, and the treatment strategy has gradually reached consensus. However, there are few reported cases of laparoscopic caudate lobe tumor resection, and the lack of experience in surgical treatment has not yet formed a standard. This article will discuss the laparoscopic caudate tumor resection and summarize the experience to guide the future. Objective: to discuss the preoperative diagnosis, surgical approach, surgical approach, operation experience, safety and feasibility of laparoscopic caudate lobe tumor resection. Methods: from June 2015 to December 2016, 9 cases of laparoscopic resection of liver caudate lobe tumor were performed from the Qilu Hospital of Shandong University, from preoperative diagnosis, surgical approach, operation method and postoperative recovery. Results: the clinical data were analyzed. Results: all the 9 cases were performed successfully by the senior professional surgeon of the liver surgery. All the operations were completed successfully. The tumor was completely removed. The operation time was 75min-285min. The average blood loss was 50mL-350mL, the average blood loss was 133.3mL, and 4 of the.9 cases during the operation were not transfusions to the first hepatic portal. There were 3 cases of 21min, 20min, 15min.9 cases, of which 2 were right approach, 4 had left and right approach, and 3 chose left side approach. There were no injuries to the first hepatic portal, second hepatic portal, inferior vena cava and no massive hemorrhage during the operation. The postoperative pathology was 4 cases of medium differentiated hepatocytes. Liver cancer, 4 cases of hepatic cavernous hemangioma, 1 cases of focal nodular hyperplasia of the liver,.9 patients were hospitalized for 6 days after 6 days -14 days, the average hospitalization days were 8.2 days,.1 cases of primary liver cancer were treated with yellow green poplar liquid in the abdominal drainage tube after operation. The patient's condition was more stable and no serious complications. The patients were given anti-inflammatory, liver protection, acid inhibition, nutritional support treatment and good recovery after recovery. The hospitalization expenses of the patients were 38241.35 yuan -82452 yuan, and the average cost was 55464.83 yuan. Conclusion: the liver caudate lobe tumors generally appear to be upper abdominal or right upper abdominal pain, abdominal distention, discomfort after eating, partial patients after eating, some patients. There is no symptom. It is of great significance for the preoperative diagnosis and choice of surgical methods for caudate lobe tumor. The location of caudate lobe is special and the surrounding anatomy is complex. When the tumor is excised, it should be based on the location, size, and other liver segments around the tumor. The right or right side of the caudate lobe can be used in the right or left side of the right part of the caudate lobe. The left tumor of the left caudate leaf can choose the left approach or the left and right combined approach. The combined approach is the most surgical approach at present. The laparoscopic caudate tumor resection is suitable for caudate leaf disease. If the tumor is small and confined to the caudate lobe, if the tumor is huge, the tumor should be removed from the other hepatic segments or other hepatic segments. In the operation, the gap between the caudate and the inferior vena cava should be examined carefully and the short vein of the liver is clipped and cut off one by one. The first porta hepatis, and the important vessels at the second hilum of the liver should be treated. To avoid injury, we can preposition the blockage of the first hepatic portal and block the hepatic portal under the condition of more bleeding. Before operation, the patient is examined fully and the patient's condition is evaluated. The surgery of a highly experienced surgeon and the laparoscopic hepatectomy for the liver caudate lobe tumor are complicated, but safe, feasible, and treated. The effect is good.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.7
本文編號：2173816
[Abstract]:Background: the liver caudate lobe is located in the central position of the posterior part of the liver, and its local anatomy is complicated. The surgical treatment of the lesion is always the difficult point in the Department of hepatobiliary surgery. With the further research, the cases of caudate tumor surgery are gradually increasing, and the treatment strategy has gradually reached consensus. However, there are few reported cases of laparoscopic caudate lobe tumor resection, and the lack of experience in surgical treatment has not yet formed a standard. This article will discuss the laparoscopic caudate tumor resection and summarize the experience to guide the future. Objective: to discuss the preoperative diagnosis, surgical approach, surgical approach, operation experience, safety and feasibility of laparoscopic caudate lobe tumor resection. Methods: from June 2015 to December 2016, 9 cases of laparoscopic resection of liver caudate lobe tumor were performed from the Qilu Hospital of Shandong University, from preoperative diagnosis, surgical approach, operation method and postoperative recovery. Results: the clinical data were analyzed. Results: all the 9 cases were performed successfully by the senior professional surgeon of the liver surgery. All the operations were completed successfully. The tumor was completely removed. The operation time was 75min-285min. The average blood loss was 50mL-350mL, the average blood loss was 133.3mL, and 4 of the.9 cases during the operation were not transfusions to the first hepatic portal. There were 3 cases of 21min, 20min, 15min.9 cases, of which 2 were right approach, 4 had left and right approach, and 3 chose left side approach. There were no injuries to the first hepatic portal, second hepatic portal, inferior vena cava and no massive hemorrhage during the operation. The postoperative pathology was 4 cases of medium differentiated hepatocytes. Liver cancer, 4 cases of hepatic cavernous hemangioma, 1 cases of focal nodular hyperplasia of the liver,.9 patients were hospitalized for 6 days after 6 days -14 days, the average hospitalization days were 8.2 days,.1 cases of primary liver cancer were treated with yellow green poplar liquid in the abdominal drainage tube after operation. The patient's condition was more stable and no serious complications. The patients were given anti-inflammatory, liver protection, acid inhibition, nutritional support treatment and good recovery after recovery. The hospitalization expenses of the patients were 38241.35 yuan -82452 yuan, and the average cost was 55464.83 yuan. Conclusion: the liver caudate lobe tumors generally appear to be upper abdominal or right upper abdominal pain, abdominal distention, discomfort after eating, partial patients after eating, some patients. There is no symptom. It is of great significance for the preoperative diagnosis and choice of surgical methods for caudate lobe tumor. The location of caudate lobe is special and the surrounding anatomy is complex. When the tumor is excised, it should be based on the location, size, and other liver segments around the tumor. The right or right side of the caudate lobe can be used in the right or left side of the right part of the caudate lobe. The left tumor of the left caudate leaf can choose the left approach or the left and right combined approach. The combined approach is the most surgical approach at present. The laparoscopic caudate tumor resection is suitable for caudate leaf disease. If the tumor is small and confined to the caudate lobe, if the tumor is huge, the tumor should be removed from the other hepatic segments or other hepatic segments. In the operation, the gap between the caudate and the inferior vena cava should be examined carefully and the short vein of the liver is clipped and cut off one by one. The first porta hepatis, and the important vessels at the second hilum of the liver should be treated. To avoid injury, we can preposition the blockage of the first hepatic portal and block the hepatic portal under the condition of more bleeding. Before operation, the patient is examined fully and the patient's condition is evaluated. The surgery of a highly experienced surgeon and the laparoscopic hepatectomy for the liver caudate lobe tumor are complicated, but safe, feasible, and treated. The effect is good.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.7
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，本文編號：2173816
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