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中华肝脏外科手术学电子杂志 ›› 2025, Vol. 14 ›› Issue (03) : 430 -434. doi: 10.3877/cma.j.issn.2095-3232.2025.03.015

临床研究

背侧入路在腹腔镜肝尾状叶腔静脉旁部切除术中的应用
颜玉杰1, 吴炅1, 段文斌1, 陈博滔1, 王小辉1, 毛先海1, 段小辉1,()   
  1. 1. 410005 长沙,湖南师范大学附属第一医院(湖南省人民医院)肝胆外科
  • 收稿日期:2024-08-28 出版日期:2025-06-10
  • 通信作者: 段小辉
  • 基金资助:
    湖南省自然科学基金科卫联合项目(2022JJ70015)湖南省重点研发项目(2023SK2060)

Dorsal approach in laparoscopic resection of paracaval portion of the caudate lobe

Yujie Yan1, Jiong Wu1, Wenbin Duan1, Botao Chen1, Xiaohui Wang1, Xianhai Mao1, Xiaohui Duan1,()   

  1. 1. Department of Hepatobiliary Surgery, the First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital),Changsha 410005, China
  • Received:2024-08-28 Published:2025-06-10
  • Corresponding author: Xiaohui Duan
引用本文:

颜玉杰, 吴炅, 段文斌, 陈博滔, 王小辉, 毛先海, 段小辉. 背侧入路在腹腔镜肝尾状叶腔静脉旁部切除术中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(03): 430-434.

Yujie Yan, Jiong Wu, Wenbin Duan, Botao Chen, Xiaohui Wang, Xianhai Mao, Xiaohui Duan. Dorsal approach in laparoscopic resection of paracaval portion of the caudate lobe[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(03): 430-434.

目的

探讨背侧入路在腹腔镜肝尾状叶腔静脉旁部切除术中的应用。

方法

回顾性分析2020年1月至2023年7月湖南师范大学附属第一医院收治的6例肝尾状叶腔静脉旁部切除术患者的临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男2例,女4例,年龄(47±12)岁。所有患者均采用经背侧入路完成腹腔镜肝尾状叶腔静脉旁部切除术。观察患者围手术期情况和并发症等。

结果

6例患者手术时间为(158±28)min,第一肝门阻断时间为(40±16)min;术中出血量为147(50~280)ml,无术中输血。6例患者术后住院时间为3.0~7.0 d,中位住院时间5.3 d。术后未发生出血、胆漏等严重并发症。术后病理学检查结果提示肝海绵状血管瘤2例,直径分别为7.2、9.0 cm;肝局灶性结节增生2例,直径分别为5.2、5.9 cm;肝细胞癌1例,直径为2.7 cm,肝内胆管癌1例,直径为2.5 cm。

结论

对于熟练的腹腔镜团队,腔静脉旁部的良性肿瘤和经过病例筛选的部分恶性肿瘤患者,经背侧入路行腹腔镜肝尾状叶腔静脉旁部切除术安全、可行。

Objective

To investigate the application of dorsal approach in laparoscopic resection of paracaval portion of the caudate lobe.

Methods

Clinical data of 6 patients undergoing laparoscopic resection of paracaval portion of the caudate lobe in the First Affiliated Hospital of Hunan Normal University from January 2020 to July 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 2 patients were male and 4 female, aged (47±12) years. All patients underwent laparoscopic resection of paracaval portion of the caudate lobe via dorsal approach. Perioperative conditions and complications were observed.

Results

The operation time of 6 patients was (158±28) min. The occlusion time of porta hepatis was (40±16) min.Intraoperative blood loss was 147 (50±280) ml. No intraoperative blood transfusion was given. The length of postoperative hospital stay of 6 patients was 3.0-7.0 d, with a median of 5.3 d. No severe complications such as bleeding and bile leakage occurred after operation. Postoperative pathological examination showed that 2 cases were diagnosed with hepatic cavernous hemangioma with a diameter of 7.2 and 9.0 cm, 2 cases of focal nodular hyperplasia with a diameter of 5.2 and 5.9 cm, 1 case of hepatocellular carcinoma with a diameter of 2.7 cm and 1 case of intrahepatic cholangiocarcinoma with a diameter of 2.5 cm, respectively.

Conclusions

For experienced laparoscopic team, it is safe and feasible to perform laparoscopic resection of paracaval portion of the caudate lobe via dorsal approach for patients with benign paracaval tumors and eligible patients with malignant tumors after screening.

图1 背侧入路腹腔镜肝尾状叶腔静脉旁部切除术左侧俯卧位及Trocar位置示意图
图2 经背侧入路腹腔镜肝尾状叶腔静脉旁部切除术
图3 一例经背侧入路腹腔镜肝尾状叶腔静脉旁部切除术患者术前及术后CT图
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