中国普外基础与临床杂志

中国普外基础与临床杂志

术前三维重建辅助并存血管变异的腹腔镜肝癌切除术

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目的 探讨存在血管变异的肝癌患者行腹腔镜肝切除术的可行性及安全性。 方法 回顾性分析 2017 年 10 月陆军军医大学第二附属医院肝胆外科收治的 1 例术前诊断为原发性肝癌患者的临床资料,基于术前 CT 数据进行三维重建并进行肝脏体积计算,从而制定手术规划并进行手术。 结果 三维重建结果提示肿瘤位于右肝中心区域且涵盖Ⅴ、Ⅵ、Ⅶ、Ⅷ段,门静脉存在Ⅱ型变异,门静脉右前支有走向左内叶的分支,右肝静脉分为腹侧支及背侧支,存在粗大的肝右后下静脉。术前规划:右后叶切除、右前叶切除均不能完整切除肿瘤;若按照标准右半肝切除,剩余肝脏体积占标准肝体积的 27%;若保留门静脉右前支主干行右肝部分切除术,剩余肝脏体积占标准肝体积的 41%。根据精准肝切除理念,行腹腔镜下保留门静脉右前支主干的右肝部分切除术,手术过程顺利。术后肝功能恢复良好。术后出现右侧胸腔积液,经胸腔穿刺抽液后缓解,患者顺利出院。 结论 本病例研究结果提示,对于存在血管变异的肝癌病例,在三维重建技术指导下行腹腔镜下肝部分切除术可增加手术安全性。

Objective To investigate feasibility and safety of laparoscopic liver resection with vascular variation. Methods The clinical data of one patient with preoperative diagnosis of primary liver cancer, who was admitted into the Department of Hepatobiliary Surgery of the Second Affiliated hospital of Army Military University in October 2017, were analyzed retrospectively. The three-dimensional (3D) reconstruction was completed basing on the preoperative CT data, then the liver volume was calculated and the preoperative planning was made, finally the subsequent surgery was performed. Results The results of the 3D reconstruction suggested that the tumor was situated in the central of the right liver, including the segment Ⅴ, Ⅵ, Ⅶ, and Ⅷ. There was a type Ⅱ portal vein variation, the right anterior branch of the portal vein divided a branch into the left medial lobe. The right hepatic vein was divided into the ventral and dorsal branches. There was a thick right posterior inferior vein in this case. The preoperative planning was that the right posterior lobectomy and right anterior lobectomy could not completely remove the tumor. According to the standard right hemihepatectomy, the remaining liver volume accounted for 27% of the standard liver volume. If preserving the right anterior branch of the portal vein for the right hemihepatectomy, the remaining liver volume accounted for 41% of the standard liver volume. According to the concept of precise hepatectomy, the laparoscopic partial right hepatectomy with preservation of the main branch of the right anterior portal vein was performed smoothly. The liver function recovered well after the surgery. The right pleural effusion appeared after the surgery, then was relieved by the thoracentesis. Conclusion For primary liver cancer patient with vascular variation, laparoscopic liver resection is feasible and safe basing on guide of 3D reconstruction technology.

关键词: 腹腔镜肝切除; 三维重建; 精准肝切除; 血管变异

Key words: laparoscopic liver resection; three-dimensional reconstruction; precise hepatectomy; vascular variation

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