探讨腹腔镜单纯肝尾状叶切除的安全性、疗效及优势。

回顾性分析2016年6月至2018年6月在四川大学华西医院行单纯肝尾状叶切除的17例患者临床资料。患者签署知情同意书，符合医学伦理学规定。其中男11例，女6例；年龄24～73岁，中位年龄50岁。根据手术方式不同，分为腹腔镜单纯尾状叶切除组（腔镜组，10例）和开腹单纯尾状叶切除组（开腹组，7例）。两组患者围手术期指标比较采用t检验或秩和检验。

两组均顺利完成手术，均未行肝下下腔静脉阻断，术中均未出现难以控制的大出血。腔镜组平均手术时间、肝门阻断时间分别为（2.7±0.9） h、（25±10）min，明显少于开腹组的（3.6±0.5）h、（37±12）min（t=-2.382，-2.365；P<0.05）。腔镜组术中出血量中位数为75（40～300）ml，明显少于开腹组的200（200～500）ml （Z=-3.035，P<0.05）。术后仅开腹组1例患者出现腹腔积液，经补充白蛋白及利尿治疗后好转出院。腔镜组术后1 d的ALB为（35±2）g/L，明显高于开腹组的（32±2）g/L（t=3.109，P<0.05）。腔镜组术后住院时间为2（1～4）d，明显少于开腹组的4（4～6）d（Z =-3.137，P<0.05）。

在合理掌握适应证的情况下，腹腔镜单纯肝尾状叶切除是一种安全有效的手术方式，具有手术时间短、术中出血量少、术后恢复快等优势。

To evaluate the safety, clinical efficacy and advantages of laparoscopic caudate lobe resection.

Clinical data of 17 patients undergoing laparoscopic single caudate lobe resection in West China Hospital of Sichuan University from June 2016 to June 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 11 patients were male and 6 female, aged 24-73 years with a median age of 50 years. According to different surgical procedures, all patients were divided into the laparoscopic caudate lobe resection group (laparoscopic group, n=10) and open caudate lobe resection group (open group, n=7). The perioperative parameters were statistically compared between two groups by t test or rank-sum test.

All patients in both groups completed the operation successfully. No inferior vena cava occlusion was performed. No uncontrollable massive hemorrhage occurred intraoperatively. In the laparoscopic group, the average operation time was (2.7±0.9) h and hepatic portal occlusion time was (25±10) min,significantly shorter than (3.6±0.5) h and (37±12) min in the open group (t=-2.382, -2.365; P<0.05). In the laparoscopic group, the median intraoperative blood loss was 75(40-300) ml, significantly less compared with 200(200-500) ml in the open group (Z=-3.035, P<0.05). After operation, only 1 case in the open group developed ascites. This patient recovered and was discharged after receiving albumin and diuretic. In the laparoscopic group, the ALB at postoperative 1 d was (35±2) g/L, significantly higher than (32±2) g/L in the open group (t=3.109, P<0.05). In the laparoscopic group, the postoperative length of hospital stay was 2(1-4) d, significantly shorter than 4(4-6) d in the open group (Z=-3.137, P<0.05).

Laparoscopic caudate lobe resection is a safe and effective surgical approach for patients with suitable indications. It has advantages of short operation time, slight intraoperative blood loss and rapid postoperative recovery.