探讨三维（3D）腹腔镜下解剖性肝切除术治疗肝脏肿瘤的应用价值。

回顾性分析2013年9月至11月在中山大学孙逸仙纪念医院行3D腹腔镜下解剖性肝切除术的10例肝脏肿瘤患者临床资料。其中男7例，女3例；年龄36～62岁，中位年龄49岁。原发病：原发性肝癌（肝癌）8例，肝血管瘤2例。所有患者均签署知情同意书，符合医学伦理学规定。患者均在气管插管全身麻醉下行3D腹腔镜下解剖性肝切除术，手术者及助手均佩戴专用的3D眼镜，从脐部切口插入3D腹腔镜后，分别于上腹部不同位置置入5 mm或10 mm套管针3～4个，建立操作通道，然后按病变部位进行解剖性肝切除术。观察患者手术方式、术中出血量、住院时间和术后并发症发生情况。

全组10例患者均在3D腹腔镜下完成解剖性肝切除术，术中无中转开腹。其中行右半肝切除术和肝Ⅴ+Ⅵ段切除术各3例，肝左外叶切除术2例，肝中叶切除术和肝Ⅴ段切除术各1例。行右半肝切除术患者的平均手术时间为（270±26）min，肝Ⅴ+Ⅵ段切除术为（122±8）min，肝左外叶切除术为（90±7）min，肝中叶切除术为245 min，肝Ⅴ段切除术为95 min。术中出血量相应为（483±104）、（233±29）、（125±35）、450、180 ml。住院时间相应为（17±5）、（11±1）、（9±1）、13、10 d。行右半肝切除术患者中有1例术后出现肝功能不全，行肝中叶切除术患者术后并发右下肺感染，其余8例患者术后无发生并发症。

3D腹腔镜对于精确分离肝内管道结构具有一定优势，并有助于控制术中出血，适用于肝脏肿瘤解剖性肝切除术，尤其适用于半肝切除术。

To investigate the value of three dimensional (3D) laparoscopic anatomical hepatectomy for liver tumors.

Clinical data of 10 patients with liver tumors who underwent 3D laparoscopic anatomical hepatectomy in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from September to November 2013 were analyzed retrospectively. There were 7 males and 3 females with age ranging from 36 to 62 years old and the median age of 49 years old. The primary disease were primary liver cancer (n=8), hepatic hemangioma(n=2). The informed consents of all patients were obstained and the ethical committee approval was received. All the patients underwent 3D laparoscopic anatomical hepatectomy through endotracheal general anesthesia. The operators and assistants wore special 3D glasses. After the 3D laparoscope was inserted through the navel incision, operation channels were established by putting 3 to 4 trocars (5 mm or 10 mm) at different positions of upper abdomen respectively, and then anatomical hepatectomy was performed according to the diseased region. The operaton procedures, intraoperative blood loss, length of hospital stay and postoperative complications of patients were observed.

All the 10 patients underwent anatomical hepatectomy through 3D laparoscope, and no case converted to open surgery during the operation. Three cases received right hemihepatectomy, 3 cases received segment Ⅴ+Ⅵ hepatectomy, 2 cases received hepatic left lateral lobectomy, 1 case received mesohepatectomy, and 1 case received segment Ⅴ hepatectomy. The average operation duration of patients who underwent right hemihepatectomy was (270±26)min, segment Ⅴ+Ⅵ hepatectomy was (122±8)min, hepatic left lateral lobectomy was (90±7)min, mesohepatectomy was 245 min, and segment Ⅴ hepatectomy was 95 min. The intraoperative blood loss was (483±104), (233±29), (125±35), 450, 180 ml, and the length of hospital stay was (17±5), (11±1), (9±1), 13, 10 d accordingly. Liver disfunction was observed in 1 case out of the patients after right hemihepatectomy. Right lower lung infection was observed in the patient after mesohepatectomy. No complication was observed in the other 8 patients after operations.

The 3D laparoscope has a certain advantage in dissecting the intrahepatic ductal structures precisely, and can help to control the intraoperative blood loss. It is applicable to anatomical hepatectomy for liver tumors, especially to hemihepatectomy.