改良腹腔镜肝右叶血管瘤切除的临床应用研究
发布时间：2018-11-06 09:22
【摘要】：目的:肝血管瘤是最常见的肝脏良性肿瘤。肝血管瘤切除术是当前其最有疗效的医治方法。自1991年Reich成功的将腹腔镜技术应用于肝脏部分切除术以来,越来越多的肝脏手术能够腹腔镜下完成。腹腔镜手术相较于开腹手术,具备创伤小、恢复快等明显优点。目前腹腔镜手术已经成为肝脏手术的常规手术方式。但是由于肝脏特殊的解剖特点,特别是对于肝脏右叶的肿瘤,操作空间狭小,术中暴露和止血相对困难,腹腔镜肝脏手术对操作者技术要求较高,成为制约腹腔镜技术在肝胆外科普及的因素。此研究的目的是研究腹腔镜手术治疗肝右叶血管瘤的可行性、安全性以及总结我科自开展腹腔镜技术以来,在腹腔镜肝脏手术方面的手术经验及手术技巧。资料和方法:参照本次研究病例选择的纳入标准和排除标准,回顾性分析自2012年11月至2016年9月60例于山东大学齐鲁医院因肝右叶血管瘤行改良腹腔镜肝血管瘤切除术的患者的一般资料及临床资料。60例肝右叶血管瘤患者术前均通过影像学确诊,所有患者术前检查其凝血功能、肝功能、AFP均正常。通过总结实施手术的时间、术中的出血量、术中是否输血、实行肝门阻断的时间、是否中转开腹、围手术期患者肝功能变化、术后引流管的携带时间、术后并发症的发生率、术后住院天数等资料,分析腹腔镜技术治疗肝右叶血管瘤的可行性、安全性。结果:统计60例患者的临床研究资料,60例肝血管瘤手术均在腹腔镜下完成,无一例中转开腹。手术平均时间为(141.0±33.6)min,术中平均出血量为(168.7±129.8)ml,肝门平均阻断时间(21.5±7.2)min,术中及术后均未输血,术后引流管平均携带时间为(5.8±2.2)d,术后平均住院天数为(10.0±2.3)d。术后未出现大出血、胆瘘等对患者健康产生严重影响的并发症,30天及90天病死率为0。结论:通过60例腹腔镜肝右叶血管瘤切除术的临床资料的分析,我们可以发现腹腔镜技术在针对解剖位置位于右肝的肝血管瘤的治疗中均具有良好的效果与安全性。由于肝脏本身的解剖特点,肝脏位置深后,形态不规则,术野小,游离显露不易,肝脏是由肝动脉与门静脉双重供血,本身又有复杂的管道结构,在实施肝脏切除时极易出血,因此肝脏手术特别是肝右叶的良恶性肿瘤在腹腔镜下解剖暴露、止血、肝门阻断等方面难度较大,大大增大了手术难度。采用我科改良的腹腔镜技术,能够使手术难度和手术风险大大降低,可以保障腹腔镜肝右叶血管瘤的切除能安全、有效的完成,值得在临床上推广。在将来肝右叶血管瘤的治疗中,我们在完善术前评估、选择合适的病例的前提下,可以将腹腔镜肝血管瘤切除术视为一种安全、有效的治疗肝右叶血管瘤的手术方式。
[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 卤33. 6) min,. The mean blood loss was (168.7 卤129.8) ml,. The mean time of hepatic hilus occlusion was (21. 5 卤7. 2) min, during and after operation. The average carrying time of the drainage tube was (5.8 卤2.2) days, and the average postoperative hospitalization time was (10.0 卤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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7
本文编号：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 卤33. 6) min,. The mean blood loss was (168.7 卤129.8) ml,. The mean time of hepatic hilus occlusion was (21. 5 卤7. 2) min, during and after operation. The average carrying time of the drainage tube was (5.8 卤2.2) days, and the average postoperative hospitalization time was (10.0 卤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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7
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