目的：探讨腹腔镜超声（ laparoscopic ultrasonography ， LUS ）在腹腔镜解剖性肝切除术（ laparoscopic anatomical hepatectomy ，LAH）中的应用价值。方法回顾性分析李惠利医院微创外科2008年9月～2011年9月腹腔镜解剖性肝切除32例临床资料。肝内胆管结石14例，原发性肝癌6例，肝血管瘤4例，肝局灶性增生2例，结直肠癌肝转移6例。术中使用LUS检查，帮助了解腹腔镜解剖性肝切除的手术解剖入路，确定肿瘤分期、切缘，良、恶病灶和周围肝内管道之间的关系。结果27例（84％）按原定手术计划完成手术，2例（6％）根据LUS发现及时更改了手术计划（1例为左肝内胆管结石遗漏胆总管小结石，1例Ⅴ段原发性肝癌患者遗漏肝脏Ⅵ段直径6 mm卫星灶），3例（9％）因LUS发现肿瘤无法切除终止手术。结论 LUS提高手术的精准性、安全性和彻底性，发现术前影像检查的漏诊或误诊以指导手术，避免不必要的剖腹探查，值得推广。%Objective To evaluate the role of laparoscopic ultrasonography ( LUS) in laparoscopic anatomical hepatectomy . Methods The data of 32 patients undergoing laparoscopic anatomical hepatectomy in Minimally Invasive Surgery Department of Lihuili Hospital between September 2008 and September 2011 were retrospectively analyzed .Of all the patients , there were 14 cases of calculus in intrahepatic duct , 6 cases of hepatocellular carcinoma , 4 cases of liver hemangioma , 2 cases of liver focal hyperplasia , and 6 cases of liver metastases from colorectal cancer .LUS was used during all the operations in order to investigate the anatomy of the operations , determine the tumor stage and guide the incision margin of tumor .It was conventionally used to detect the relationship between the lesions and peripheral intrahepatic vessels and ducts . Results In the 32 cases, 27 cases (84%) completed the operations on schedule , two cases (6%) altered the planned surgical procedures owing to the findings of LUS , including one case of left hepatolithiasis found a small stone in the common bile duct , and one case of hepatocellular carcinoma located in the V segment found a satellite lesion in Ⅵ segment ( 6 mm in diameter ) .The other three cases ( 9%) terminated the operation because LUS indicated the tumors were unresectable . Conclusions LUS can improve the accuracy , safety and thoroughness of the surgery .It gives accurate guidance to the surgeons by detecting missed or wrong diagnosis and avoids unnecessary exploratory laparotomy .
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