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目的探讨腹腔镜肝血管瘤手术的可行性和疗效。方法回顾性分析2003年11月至2009年10月广西医科大学第一附属医院微创外科中心进行的43例腹腔镜肝血管瘤手术病例的临床资料。肝门阻断采用自制的肝门阻断器或进行半肝阻断,根据肿瘤的部位和血管的关系进行血管瘤剜除术、肝左外叶切除或部分切除术。使用电刀、超声刀等进行切除。结果 41例成功应用腹腔镜完成手术,2例因大出血中转开腹手术,中转率为4.6%(2/43)。无死亡病例,肿瘤直径为(6.24±2.87)cm,手术时间为(125.27±74.76)min,肝门阻断时间为(11.27±14.11)min。术中出血量为(285.50±425.04)mL,术中输血(1.22±2.57)单位,术后引流量为(169.61±224.43)mL,术后恢复活动时间为(2.20±0.99)d,术后住院时间为(8.5±3.6)d。总住院时间为(17.5±7.4)d,总住院费用为(11441.6±9668.7)元。术后2例出现并发症,发生率为4.8%,胆漏1例,肝下脓肿1例,均经保守治疗痊愈。结论选择合适的病例,掌握肝门阻断技术,腹腔镜肝血管瘤手术是安全、可行的。
Objective To investigate the feasibility and efficacy of laparoscopic hepatic hemangioma surgery. Methods The clinical data of 43 patients with laparoscopic hepatic hemangiomas underwent surgery from January 2003 to October 2009 at the Minimally Invasive Surgery Center of the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed. Hepatic portal block using a home-made hepatic portal block or block the hemi-liver, according to the tumor site and the relationship between vascular hemangiomas surgery, left hepatectomy or partial resection. Use electric knife, ultrasonic knife and so on. Results Successful laparoscopic surgery was performed in 41 cases and laparoscopic surgery in 2 cases. The conversion rate was 4.6% (2/43). No deaths were found. The tumor diameter was (6.24 ± 2.87) cm, the operation time was (125.27 ± 74.76) min, and the time of hepatic portal obstruction was (11.27 ± 14.11) min. The blood loss during operation was (285.50 ± 425.04) mL, and the intraoperative blood transfusion was (1.22 ± 2.57) units. The postoperative drainage volume was (169.61 ± 224.43) mL and the postoperative recovery activity time was (2.20 ± 0.99) Time was (8.5 ± 3.6) d. The total length of hospital stay was (17.5 ± 7.4) days and the total cost of hospitalization was (11441.6 ± 9668.7) yuan. Postoperative complications occurred in 2 cases, the incidence was 4.8%, 1 case of bile leakage, 1 case of liver abscess, were cured by conservative treatment. Conclusion Select the appropriate case, grasp the hilar blocking technique, laparoscopic hepatic hemangioma surgery is safe and feasible.