改良腹腔鏡肝右葉血管瘤切除的臨床應(yīng)用研究
發(fā)布時(shí)間：2018-11-06 09:22
【摘要】：目的:肝血管瘤是最常見的肝臟良性腫瘤。肝血管瘤切除術(shù)是當(dāng)前其最有療效的醫(yī)治方法。自1991年Reich成功的將腹腔鏡技術(shù)應(yīng)用于肝臟部分切除術(shù)以來,越來越多的肝臟手術(shù)能夠腹腔鏡下完成。腹腔鏡手術(shù)相較于開腹手術(shù),具備創(chuàng)傷小、恢復(fù)快等明顯優(yōu)點(diǎn)。目前腹腔鏡手術(shù)已經(jīng)成為肝臟手術(shù)的常規(guī)手術(shù)方式。但是由于肝臟特殊的解剖特點(diǎn),特別是對(duì)于肝臟右葉的腫瘤,操作空間狹小,術(shù)中暴露和止血相對(duì)困難,腹腔鏡肝臟手術(shù)對(duì)操作者技術(shù)要求較高,成為制約腹腔鏡技術(shù)在肝膽外科普及的因素。此研究的目的是研究腹腔鏡手術(shù)治療肝右葉血管瘤的可行性、安全性以及總結(jié)我科自開展腹腔鏡技術(shù)以來,在腹腔鏡肝臟手術(shù)方面的手術(shù)經(jīng)驗(yàn)及手術(shù)技巧。資料和方法:參照本次研究病例選擇的納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),回顧性分析自2012年11月至2016年9月60例于山東大學(xué)齊魯醫(yī)院因肝右葉血管瘤行改良腹腔鏡肝血管瘤切除術(shù)的患者的一般資料及臨床資料。60例肝右葉血管瘤患者術(shù)前均通過影像學(xué)確診,所有患者術(shù)前檢查其凝血功能、肝功能、AFP均正常。通過總結(jié)實(shí)施手術(shù)的時(shí)間、術(shù)中的出血量、術(shù)中是否輸血、實(shí)行肝門阻斷的時(shí)間、是否中轉(zhuǎn)開腹、圍手術(shù)期患者肝功能變化、術(shù)后引流管的攜帶時(shí)間、術(shù)后并發(fā)癥的發(fā)生率、術(shù)后住院天數(shù)等資料,分析腹腔鏡技術(shù)治療肝右葉血管瘤的可行性、安全性。結(jié)果:統(tǒng)計(jì)60例患者的臨床研究資料,60例肝血管瘤手術(shù)均在腹腔鏡下完成,無一例中轉(zhuǎn)開腹。手術(shù)平均時(shí)間為(141.0±33.6)min,術(shù)中平均出血量為(168.7±129.8)ml,肝門平均阻斷時(shí)間(21.5±7.2)min,術(shù)中及術(shù)后均未輸血,術(shù)后引流管平均攜帶時(shí)間為(5.8±2.2)d,術(shù)后平均住院天數(shù)為(10.0±2.3)d。術(shù)后未出現(xiàn)大出血、膽瘺等對(duì)患者健康產(chǎn)生嚴(yán)重影響的并發(fā)癥,30天及90天病死率為0。結(jié)論:通過60例腹腔鏡肝右葉血管瘤切除術(shù)的臨床資料的分析,我們可以發(fā)現(xiàn)腹腔鏡技術(shù)在針對(duì)解剖位置位于右肝的肝血管瘤的治療中均具有良好的效果與安全性。由于肝臟本身的解剖特點(diǎn),肝臟位置深后,形態(tài)不規(guī)則,術(shù)野小,游離顯露不易,肝臟是由肝動(dòng)脈與門靜脈雙重供血,本身又有復(fù)雜的管道結(jié)構(gòu),在實(shí)施肝臟切除時(shí)極易出血,因此肝臟手術(shù)特別是肝右葉的良惡性腫瘤在腹腔鏡下解剖暴露、止血、肝門阻斷等方面難度較大,大大增大了手術(shù)難度。采用我科改良的腹腔鏡技術(shù),能夠使手術(shù)難度和手術(shù)風(fēng)險(xiǎn)大大降低,可以保障腹腔鏡肝右葉血管瘤的切除能安全、有效的完成,值得在臨床上推廣。在將來肝右葉血管瘤的治療中,我們?cè)谕晟菩g(shù)前評(píng)估、選擇合適的病例的前提下,可以將腹腔鏡肝血管瘤切除術(shù)視為一種安全、有效的治療肝右葉血管瘤的手術(shù)方式。
[Abstract]:Objective: hepatic hemangioma is the most common benign tumor of the liver. Hepatic hemangioma resection is currently the most effective treatment. Since Reich successfully applied laparoscopic technique to partial hepatectomy in 1991, more and more liver operations have been performed under laparoscope. Compared with open surgery, laparoscopic surgery has the advantages of less trauma and faster recovery. At present, laparoscopic surgery has become a routine method of liver surgery. However, due to the special anatomical characteristics of the liver, especially for the tumor in the right lobe of the liver, the operation space is narrow, the exposure during operation and hemostasis are relatively difficult, the technical requirements of the operator are high for laparoscopic liver surgery. Become the factor that restricts the popularization of laparoscopic technique in hepatobiliary surgery. The purpose of this study is to study the feasibility and safety of laparoscopic surgery for hepatic right lobe hemangioma, and to summarize the experience and techniques of laparoscopic liver surgery since the development of laparoscopic surgery. Information and methods: referring to the inclusion criteria and exclusion criteria for case selection in this study, From November 2012 to September 2016, the general data and clinical data of 60 patients with hepatic right lobe hemangioma treated by modified laparoscopic hepatic hemangioma in Qilu Hospital of Shandong University were analyzed retrospectively. 60 patients with right lobe hemangioma of liver were treated with modified laparoscopic hepatohemangiectomy. All the patients were diagnosed by imaging before operation. All patients had normal coagulation function, liver function and AFP before operation. By summing up the time of operation, the amount of blood lost during the operation, the blood transfusion during the operation, the time of the closure of the hepatic portal, the conversion to laparotomy, the changes of the liver function of the patients during perioperative period, the carrying time of the drainage tube after operation, the incidence of postoperative complications, To analyze the feasibility and safety of laparoscopy in the treatment of right lobe hemangioma. Results: 60 cases of hepatic hemangioma were operated under laparoscope. The mean time of operation was (141.0 鹵33. 6) min,. The mean blood loss was (168.7 鹵129.8) ml,. The mean time of hepatic hilus occlusion was (21. 5 鹵7. 2) min, during and after operation. The average carrying time of the drainage tube was (5.8 鹵2.2) days, and the average postoperative hospitalization time was (10.0 鹵2.3) days. There were no postoperative complications, such as massive bleeding and biliary fistula, which had a serious effect on patients' health. The mortality of 30 days and 90 days was 0. 5%. Conclusion: according to the clinical data of 60 cases of laparoscopic right lobe hemangioma resection, we can find that laparoscopic technique has good effect and safety in the treatment of hepatic hemangioma located in the right liver. Because of the anatomical characteristics of the liver itself, the liver is in a deep position, its shape is irregular, the surgical field is small, it is not easy to be exposed, the liver is supplied by the hepatic artery and portal vein, and it has complex conduit structure, so it is easy to bleed when the liver is excised. Therefore, liver surgery, especially benign and malignant tumors in the right lobe of liver, is more difficult in dissection exposure, hemostasis and hepatic hilus blocking under laparoscope, which greatly increases the difficulty of operation. By using the improved laparoscopic technique, the difficulty and risk of operation can be greatly reduced, and the laparoscopic resection of right lobe hemangioma of the liver can be safely and effectively completed, which is worth popularizing in clinic. In the future right lobe hemangioma treatment, we can consider laparoscopic hepatic hemangioma resection as a safe and effective way to treat right hepatic lobe hemangioma under the premise of improving preoperative evaluation and selecting appropriate cases.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7
本文編號(hào)：2313870
[Abstract]:Objective: hepatic hemangioma is the most common benign tumor of the liver. Hepatic hemangioma resection is currently the most effective treatment. Since Reich successfully applied laparoscopic technique to partial hepatectomy in 1991, more and more liver operations have been performed under laparoscope. Compared with open surgery, laparoscopic surgery has the advantages of less trauma and faster recovery. At present, laparoscopic surgery has become a routine method of liver surgery. However, due to the special anatomical characteristics of the liver, especially for the tumor in the right lobe of the liver, the operation space is narrow, the exposure during operation and hemostasis are relatively difficult, the technical requirements of the operator are high for laparoscopic liver surgery. Become the factor that restricts the popularization of laparoscopic technique in hepatobiliary surgery. The purpose of this study is to study the feasibility and safety of laparoscopic surgery for hepatic right lobe hemangioma, and to summarize the experience and techniques of laparoscopic liver surgery since the development of laparoscopic surgery. Information and methods: referring to the inclusion criteria and exclusion criteria for case selection in this study, From November 2012 to September 2016, the general data and clinical data of 60 patients with hepatic right lobe hemangioma treated by modified laparoscopic hepatic hemangioma in Qilu Hospital of Shandong University were analyzed retrospectively. 60 patients with right lobe hemangioma of liver were treated with modified laparoscopic hepatohemangiectomy. All the patients were diagnosed by imaging before operation. All patients had normal coagulation function, liver function and AFP before operation. By summing up the time of operation, the amount of blood lost during the operation, the blood transfusion during the operation, the time of the closure of the hepatic portal, the conversion to laparotomy, the changes of the liver function of the patients during perioperative period, the carrying time of the drainage tube after operation, the incidence of postoperative complications, To analyze the feasibility and safety of laparoscopy in the treatment of right lobe hemangioma. Results: 60 cases of hepatic hemangioma were operated under laparoscope. The mean time of operation was (141.0 鹵33. 6) min,. The mean blood loss was (168.7 鹵129.8) ml,. The mean time of hepatic hilus occlusion was (21. 5 鹵7. 2) min, during and after operation. The average carrying time of the drainage tube was (5.8 鹵2.2) days, and the average postoperative hospitalization time was (10.0 鹵2.3) days. There were no postoperative complications, such as massive bleeding and biliary fistula, which had a serious effect on patients' health. The mortality of 30 days and 90 days was 0. 5%. Conclusion: according to the clinical data of 60 cases of laparoscopic right lobe hemangioma resection, we can find that laparoscopic technique has good effect and safety in the treatment of hepatic hemangioma located in the right liver. Because of the anatomical characteristics of the liver itself, the liver is in a deep position, its shape is irregular, the surgical field is small, it is not easy to be exposed, the liver is supplied by the hepatic artery and portal vein, and it has complex conduit structure, so it is easy to bleed when the liver is excised. Therefore, liver surgery, especially benign and malignant tumors in the right lobe of liver, is more difficult in dissection exposure, hemostasis and hepatic hilus blocking under laparoscope, which greatly increases the difficulty of operation. By using the improved laparoscopic technique, the difficulty and risk of operation can be greatly reduced, and the laparoscopic resection of right lobe hemangioma of the liver can be safely and effectively completed, which is worth popularizing in clinic. In the future right lobe hemangioma treatment, we can consider laparoscopic hepatic hemangioma resection as a safe and effective way to treat right hepatic lobe hemangioma under the premise of improving preoperative evaluation and selecting appropriate cases.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7
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