探讨Endo-GIA两步法在腹腔镜左半肝切除术中的应用价值。

回顾性分析2013年9月至2016年7月在佛山市第一人民医院采用Endo-GIA两步法行腹腔镜左半肝切除术的21例患者临床资料。其中男15例，女6例；年龄45～67岁，中位年龄55岁。患者均签署知情同意书，符合医学伦理学规定。患者气管插管全身麻醉，以电刀切开肝包膜，以超声刀断肝，腹腔镜双极电凝辅助止血。自肝脏下缘切开肝实质，待切割层面靠近第一至第二肝门平面时，用Endo-GIA闭合离断左肝蒂及其后方的部分肝组织，并将剩余肝组织和肝左静脉闭合离断。观察患者术中及术后情况。

所有患者均成功完成手术，无中转开腹病例。患者平均手术时间为（212±68） min，术中出血量（269±74）ml，无术中输血。术后住院时间（13±4）d。发生术后并发症2例，均为胆漏，经保守治疗后痊愈。

Endo-GIA两步法腹腔镜左半肝切除术具有简便、安全、成功率高的优势，为临床提供一种新的术式选择。

To investigate the application value of two-step method with Endo-GIA in laparoscopic left hepatectomy.

Clinical data of 21 patients who underwent laparoscopic left hepatectomy using two-step method with Endo-GIA in the First People's Hospital of Foshan between September 2013 and July 2016 were retrospectively analyzed. Among them, 15 cases were males and 6 females, aged 45-67 years old with a median age of 55 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients received general anesthesia by endotracheal intubation. The liver capsula was incised by electro-scalpel, the liver was resected by harmonic scalpel and the hemostasis was performed by laparoscopic bipolar coagulation. The hepatic parenchyma was incised along the lower margin of the liver. When the incising plane approached the first and second porta hepatis, the left liver pedicle and partial posterior liver tissues, residual liver tissues and left hepatic vein were occluded and cut by Endo-GIA. The intraoperative and postoperative conditions of the patients were observed.

The operation was successfully performed in all patients. No patient was switched to open surgery. The mean operation time was (212±68) min. The intraoperative blood loss was (269±74) ml. No intraoperative blood transfusion was observed. The postoperative length of hospital stay was (13±4) d. Postoperative complications of bile leakage were observed in 2 cases, and were cured after conservative therapy.

Laparoscopic left hepatectomy using two-step method with Endo-GIA has the advantages of simple, convenient, safe and high success rate, which offers a novel surgical option for clinical practice.