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[目的]探讨根据精准肝切除理念行腹腔镜肝切除治疗原发性肝癌的方法与价值。[方法]回顾分析63例原发性肝细胞癌患者,遵循精准肝切除理念行腹腔镜下精准肝切除术。手术主要方式是根据术前影像资料精确定位病变范围,根据病变范围行选择性的入肝血流阻断或行遵循肝脏内部解剖结构的规则性肝切除。[结果]63例患者中,61例完全腹腔镜下完成,2例中转开腹,中转开腹率3.17%。腹腔镜平均手术时间(210±90)min,平均出血量(400±90)ml。术后出现腹水6例,右膈下积液2例,右侧胸腔积液7例,胆瘘1例,经相应处理均顺利康复,术后平均住院时间(9±3)d。[结论]腹腔镜行选择性入肝血流阻断,并行基于肝段、叶的腹腔镜规则性肝切除术治疗肝癌是安全可行的,符合当代精准肝切除的理念,有良好的应用前景。
[Objective] To explore the method and value of laparoscopic hepatectomy for primary hepatocellular carcinoma according to the concept of precise hepatectomy. [Methods] A retrospective analysis of 63 cases of primary hepatocellular carcinoma patients, follow the concept of precise hepatectomy under laparoscopic precision hepatectomy. The main method of surgery is to accurately locate the lesion range according to the preoperative imaging data. According to the lesion range, selective hepatic blood flow occlusion or regular hepatectomy following the internal anatomy of the liver can be performed. [Results] Of the 63 patients, 61 were completed laparoscopically, 2 were converted to open laparotomy, and the rate of laparotomy was 3.17%. The average laparoscopic operation time (210 ± 90) min, the average amount of bleeding (400 ± 90) ml. Postoperative ascites in 6 cases, right subphrenic effusion in 2 cases, right pleural effusion in 7 cases, 1 case of biliary fistula, the corresponding treatment were well recovered, the average postoperative hospital stay (9 ± 3) d. [Conclusions] Laparoscopic selective hepatic blood flow occlusion is a safe and feasible method for laparoscopic hepatectomy on the basis of liver segments and lobes. It is consistent with the concept of contemporary precision hepatectomy and has a good prospect of application.