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目的探讨腹腔镜肝切除(LH)治疗肝脏恶性肿瘤的临床疗效。方法 78例肝脏恶性肿瘤患者,行腹腔镜肝切除术,统计手术时间、术中出血量、术后并发症、术后住院时间等。结果 78例患者均顺利完成手术,无中转开腹手术者。手术时间50~305 min,平均手术时间(245.8±105.4)min;术中出血量50~1300 ml,平均出血量(210.6±134.3)ml。术后1~2 d,所有患者均可自行下地活动,并拔出胃肠减压管,腹腔引流管于术后2~4 d拔除。患者多在术后1~2周肝功能恢复或接近正常水平,所有病例均未出现肝功能衰竭。术后5例出现并发症,其中2例出现胆漏,经1~2周充分引流后愈合,3例患者出现轻度腹水,经保肝利尿对症治疗后消失。术后住院时间为5~20 d,平均住院时间(7.5±1.5)d。术后随访12~48个月,无失访病例,8例肿瘤复发,其中4例因肿瘤复发转移死亡。结论腹腔镜肝切除治疗肝脏恶性肿瘤安全有效,值得临床推广。
Objective To investigate the clinical efficacy of laparoscopic hepatectomy (LH) in the treatment of hepatic malignancies. Methods Seventy eight patients with liver cancer underwent laparoscopic liver resection. The operation time, intraoperative blood loss, postoperative complications and postoperative hospital stay were analyzed. Results 78 patients completed the operation successfully, without transit laparotomy. The operation time was between 50 and 305 minutes and the average operation time was 245.8 ± 105.4 minutes. The intraoperative blood loss was between 50 and 1300 ml and the average amount of bleeding was 210.6 ± 134.3 ml. All patients were allowed to go to their own activities 1 to 2 days after operation, and the gastrointestinal decompression tube was removed. The abdominal drainage tube was removed at 2 to 4 days after operation. Most of the patients recovered or nearly normal liver function 1 to 2 weeks after operation, and no liver failure occurred in all cases. Postoperative complications occurred in 5 cases, including 2 cases of bile leakage, after 1 to 2 weeks of full drainage healed, 3 patients had mild ascites, the liver after diuretic symptomatic treatment disappeared. The postoperative hospital stay was 5 to 20 days and the average hospital stay was (7.5 ± 1.5) days. All the cases were followed up for 12-48 months. No cases were lost and 8 cases were recurrent. Among them, 4 cases died of tumor recurrence and metastasis. Conclusions Laparoscopic hepatectomy is safe and effective in the treatment of malignant liver tumors and is worthy of clinical promotion.