腹腔鏡肝切除技術的優化_《中國普外基礎與臨床雜志》

作者：

王宏光 , 張煊 , 董家鴻

中國人民解放軍總醫院肝膽外科醫院，全軍肝膽外科研究所（北京 100853）;

關鍵詞：

腹腔鏡肝切除技術優化動物模型入肝血流阻斷肝實質離斷

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目的通過動物實驗優化腹腔鏡肝切除中入肝血流阻斷技術及肝實質離斷技術。方法以10頭豬為實驗動物，以肝門阻斷鉗或可拆卸肝門阻斷鉗及鞘內解剖優化腹腔鏡下入肝血流阻斷技術；在沒有任何入肝血流阻斷的情況下，分別進行肝臟局部切除、左外側葉及左內側葉的序貫切除，肝實質離斷采用超聲刀、LigaSure、微波刀、雙極電凝、外科夾及內鏡切割閉合器完成，比較不同器械離斷肝實質的效果和安全性。結果肝門阻斷鉗或可拆卸肝門阻斷鉗行入肝血流全部阻斷或部分阻斷后，缺血部分肝臟顏色變化明顯；鞘內解剖左半肝入肝血流阻斷后，左、右半肝間的缺血線明顯；各種常用肝實質離斷器械均有其適用范圍，對其的優化使用可提高斷肝效率，減少出血。結論通過動物實驗優化的腹腔鏡入肝血流阻斷技術以及肝實質離斷技術，可為腹腔鏡解剖性廣泛肝切除的臨床應用提供依據。

引用本文： 王宏光,張煊,董家鴻. 腹腔鏡肝切除技術的優化. 中國普外基礎與臨床雜志, 2010, 17(6): 538-542. doi: 復制

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2.	Koffron AJ, Auffenberg G, Kung R, et al. Evaluation of 300 minimally invasive liver resections at a single institution: less is more [J]. Ann Surg, 2007; 246(3): 385-392; discussion 392-394.
3.	Buell JF, Koffron AJ, Thomas MJ, et al. Laparoscopic liver resection [J]. J Am Coll Surg, 2005; 200(3): 472-480.
4.	Vibert E, Perniceni T, Levard H, et al. Laparoscopic liver resection [J]. Br J Surg, 2006; 93(1): 67-72.
5.	Cherqui D. Laparoscopic liver resection [J]. Br J Surg, 2003; 90(6): 644-646.
6.	Dagher I, O’Rourke N, Geller DA, et al. Laparoscopic major hepatectomy: an evolution in standard of care [J]. Ann Surg, 2009; 250(5): 856-860.
7.	Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2,804 patients [J]. Ann Surg, 2009; 250(5): 831-841.
8.	Laurence JM, Lam VW, Langcake ME, et al. Laparoscopic hepatectomy, a systematic review [J]. ANZ J Surg, 2007; 77(11): 948-953.
9.	Delva E, Camus Y, Nordlinger B, et al. Vascular occlusions for liver resections. Operative management and tolerance to hepatic ischemia: 142 cases [J]. Ann Surg, 1989; 209(2): 211-218.
10.	王志偉, 黃宇琦, 李朝龍. 肝臟缺血再灌注損傷 [J]. 中國普外基礎與臨床雜志, 1998; 5(4): 253-254.
11.	Bismuth H. Surgical anatomy and anatomical surgery of the liver [J]. World J Surg, 1982; 6(1): 3-9.
12.	蔡秀軍, 王一帆, 梁霄, 等. 區域性血流阻斷技術在腹腔鏡肝切除術中的應用 [J]. 中華外科雜志, 2006; 44(19): 1307-1309.
13.	Smyrniotis V, Farantos C, Kostopanagiotou G, et al. Vascular control during hepatectomy: review of methods and results [J]. World J Surg, 2005; 29(11): 1384-1396.
14.	孫學軍, 盧樂, 石景森. 肝膽管結石的微創外科治療進展 [J]. 中國普外基礎與臨床雜志, 2006; 13(4): 403-405.
15.	文天夫, 嚴律南. 肝切除術中肝臟血流阻斷技術的研究進展 [J]. 中國普外基礎與臨床雜志, 2008; 15(4): 299-302.
16.	Machado MA, Makdissi FF, Bacchella T, et al. Hemihepatic ischemia for laparoscopic liver resection [J]. Surg Laparosc Endosc Percutan Tech, 2005; 15(3): 180-183.
17.	Gayet B, Cavaliere D, Vibert E, et al. Totally laparoscopic right hepatectomy [J]. Am J Surg, 2007; 194(5): 685-689.
18.	胡明根, 劉榮, 董家鴻, 等. 腹腔鏡肝切除的研究進展 [J]. 腹腔鏡外科雜志, 2007; 12(2): 174-177.
19.	Toyama Y, Miyake R, Son K, et al. Three-Port laparoscopic partial hepatectomy using an ultrasonically activated device (USAD) [J]. J Hepatobiliary Pancreat Surg, 2006; 13(4): 317-322.
20.	Campagnacci R, De Sanctis A, Baldarelli M, et al. Hepatic resections by means of electrothermal bipolar vessel device (EBVS) LigaSure V: early experience [J]. Surg Endosc, 2007; 21(12): 2280-2284.
21.	Jersenius U, Fors D, Rubertsson S, et al. Laparoscopic parenchymal division of the liver in a porcine model: comparison of the efficacy and safety of three different techniques [J]. Surg Endosc, 2007; 21(2): 315-320.
22.	Imura S, Ikegami T, Morine Y, et al. Advanced application of a vessel sealing system for major hepatic resections [J]. Surg Endosc, 2008; 22(1): 273-274.
23.	Gumbs AA, Bar-Zakai B, Gayet B. Totally laparoscopic extended left hepatectomy [J]. J Gastrointest Surg, 2008; 12(7): 1152.
24.	Gumbs AA, Gayet B. Multimedia article. Totally laparoscopic extended right hepatectomy [J]. Surg Endosc, 2008; 22(9): 2076-2077.
25.	Gumbs AA, Gayet B. Totally laparoscopic central hepatectomy [J]. J Gastrointest Surg, 2008; 12(7): 1153.
26.	Saidi RF, Ahad A, Escobar R, et al. Comparison between staple and vessel sealing device for parynchemal transection in laparoscopic liver surgery in a swine model [J]. HPB (Oxford), 2007; 9(6): 440-443.

1. Reich H, McGlynn F, DeCaprio J, et al. Laparoscopic excision of benign liver lesions [J]. Obstet Gynecol, 1991; 78(5 Pt 2): 956-958.
2. Koffron AJ, Auffenberg G, Kung R, et al. Evaluation of 300 minimally invasive liver resections at a single institution: less is more [J]. Ann Surg, 2007; 246(3): 385-392; discussion 392-394.
3. Buell JF, Koffron AJ, Thomas MJ, et al. Laparoscopic liver resection [J]. J Am Coll Surg, 2005; 200(3): 472-480.
4. Vibert E, Perniceni T, Levard H, et al. Laparoscopic liver resection [J]. Br J Surg, 2006; 93(1): 67-72.
5. Cherqui D. Laparoscopic liver resection [J]. Br J Surg, 2003; 90(6): 644-646.
6. Dagher I, O’Rourke N, Geller DA, et al. Laparoscopic major hepatectomy: an evolution in standard of care [J]. Ann Surg, 2009; 250(5): 856-860.
7. Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2,804 patients [J]. Ann Surg, 2009; 250(5): 831-841.
8. Laurence JM, Lam VW, Langcake ME, et al. Laparoscopic hepatectomy, a systematic review [J]. ANZ J Surg, 2007; 77(11): 948-953.
9. Delva E, Camus Y, Nordlinger B, et al. Vascular occlusions for liver resections. Operative management and tolerance to hepatic ischemia: 142 cases [J]. Ann Surg, 1989; 209(2): 211-218.
10. 王志偉, 黃宇琦, 李朝龍. 肝臟缺血再灌注損傷 [J]. 中國普外基礎與臨床雜志, 1998; 5(4): 253-254.
11. Bismuth H. Surgical anatomy and anatomical surgery of the liver [J]. World J Surg, 1982; 6(1): 3-9.
12. 蔡秀軍, 王一帆, 梁霄, 等. 區域性血流阻斷技術在腹腔鏡肝切除術中的應用 [J]. 中華外科雜志, 2006; 44(19): 1307-1309.
13. Smyrniotis V, Farantos C, Kostopanagiotou G, et al. Vascular control during hepatectomy: review of methods and results [J]. World J Surg, 2005; 29(11): 1384-1396.
14. 孫學軍, 盧樂, 石景森. 肝膽管結石的微創外科治療進展 [J]. 中國普外基礎與臨床雜志, 2006; 13(4): 403-405.
15. 文天夫, 嚴律南. 肝切除術中肝臟血流阻斷技術的研究進展 [J]. 中國普外基礎與臨床雜志, 2008; 15(4): 299-302.
16. Machado MA, Makdissi FF, Bacchella T, et al. Hemihepatic ischemia for laparoscopic liver resection [J]. Surg Laparosc Endosc Percutan Tech, 2005; 15(3): 180-183.
17. Gayet B, Cavaliere D, Vibert E, et al. Totally laparoscopic right hepatectomy [J]. Am J Surg, 2007; 194(5): 685-689.
18. 胡明根, 劉榮, 董家鴻, 等. 腹腔鏡肝切除的研究進展 [J]. 腹腔鏡外科雜志, 2007; 12(2): 174-177.
19. Toyama Y, Miyake R, Son K, et al. Three-Port laparoscopic partial hepatectomy using an ultrasonically activated device (USAD) [J]. J Hepatobiliary Pancreat Surg, 2006; 13(4): 317-322.
20. Campagnacci R, De Sanctis A, Baldarelli M, et al. Hepatic resections by means of electrothermal bipolar vessel device (EBVS) LigaSure V: early experience [J]. Surg Endosc, 2007; 21(12): 2280-2284.
21. Jersenius U, Fors D, Rubertsson S, et al. Laparoscopic parenchymal division of the liver in a porcine model: comparison of the efficacy and safety of three different techniques [J]. Surg Endosc, 2007; 21(2): 315-320.
22. Imura S, Ikegami T, Morine Y, et al. Advanced application of a vessel sealing system for major hepatic resections [J]. Surg Endosc, 2008; 22(1): 273-274.
23. Gumbs AA, Bar-Zakai B, Gayet B. Totally laparoscopic extended left hepatectomy [J]. J Gastrointest Surg, 2008; 12(7): 1152.
24. Gumbs AA, Gayet B. Multimedia article. Totally laparoscopic extended right hepatectomy [J]. Surg Endosc, 2008; 22(9): 2076-2077.
25. Gumbs AA, Gayet B. Totally laparoscopic central hepatectomy [J]. J Gastrointest Surg, 2008; 12(7): 1153.
26. Saidi RF, Ahad A, Escobar R, et al. Comparison between staple and vessel sealing device for parynchemal transection in laparoscopic liver surgery in a swine model [J]. HPB (Oxford), 2007; 9(6): 440-443.

《中國普外基礎與臨床雜志》

腹腔鏡肝切除技術的優化

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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《中國普外基礎與臨床雜志》

腹腔鏡肝切除技術的優化

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料