DUAN Yi-tao,ZHENG Bai-jun,GAO Ya,et al.Laparoscopic liver resection in children: a report of 4 cases[J].Journal of Clinical Pediatric Surgery,2013,12(02):110-112.[doi:10.3969/j.issn.1671— 6353.2013.02.010]
小儿腹腔镜下肝切除术4例
- Title:
- Laparoscopic liver resection in children: a report of 4 cases
- Keywords:
- Laparoscopes; Hepatectomy; Child
- 摘要:
- 目的 报告4例小儿腹腔镜肝切除术的临床经验。 方法 采用4～5 mm套管,腹压10～12 mmHg。解剖性肝左叶切除在肝外游离结扎肝左动脉和门静脉左支。超声刀离断浅部肝实质,深部用CUSA解剖出管道、Ligasure凝切,线型Endovascular离断肝静脉。非规则性肝切除不阻断或解剖肝门。切除标本套袋后经扩大的脐部或下腹部Trocar切口取出。 结果 男女各2例,年龄3个月至4岁,手术时间100～340 min,出血量20～200 mL。无术中术后并发症。肝肉芽肿患儿随访6年未发现其他部位肉芽肿,肝血管瘤随访5个月无症状。2例肝母细胞瘤患儿中,1例正在化疗中,另1例采取观察随访。 结论 选择合适病例,小儿腹腔镜肝切除术安全可行。
- Abstract:
- Objetive Laparoscopy for the resection of liver masses in children has remained undeveloped despite the wide acceptance of laparoscopy in the field of adult liver surgery.The authors report 4 cases of nonanatomical or anatomical laparoscopic hepatic resection of children. Methods Four to five trocars were placed. Pneumoperitoneum was established and maintained at 10～12 mmHg during tumor resection. For anatomical left hepatectomy the extra-hepatic artery, potal vein was isolated and ligated.The superior liver parenchyma was then dissected by using Harmonic scalpel. Moderate vessel was dissected by an ultrasonic dissector and sealed by the LigaSure(Valley lab). Finally the linear Endo-GIA was used to staple off the specimen from the hepatic vein. The specimen was removed by an extended umbilical/port incision or a small Pfannenstiel incision. Results There were 2 boys and 2 girls with an age range from 3 months to 4 years old. Operative time was between 100 minute and 340 minute with bleeding of 20～200 mL. No peri-operative complication was observed. The patients have been followed up for 3 months to 6 years and have remained asymptomatic since surgery. Conclusions These cases demonstrate the feasibility of laparoscopic hepatic resection, even for balking large tumors, employing standard principles of liver surgery and safety.
参考文献/References:
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