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The uncovered tracts and the liver wound surface were managed by some of the methods combined such as high frequency electrocoagulation, titanium clamp, suture, hemostatic gauze oppression, argon-beam coagulation, protein glue adherence, and Endo-GIA switcher. The total operative outcome, operating time, blood loss, postoperative complications and postoperative hospital stay were summarized in order to assess feasibility and safety of the clinical laparoscopic liver resection.Results: 1. Laparoscopic liver resection with clamp dissection method needs only the ordinary laparoscopic equipment. It has a low cost but causes a little more bleeding. 2. Laparoscopic liver resection operated by microwave tissue coagulation method had very little bleeding when dissecting hepatic parenchyma. The operative field is clear and the cost is low. It is a safe, convenient and effective method. 3. Ultrasound dissector is a relatively ideal appliance for laparoscopic liver resection at present because ofless bleeding during operation. But the speed is slow thus prolongs the operation time. Its separating intensity is not strong enough, and it can only be applied to patients without hepatic cirrhosis. 4. Ligsure has clamp dissection and electrocoagulation functions. It can carbonize hepatic tissue including the tracts whose diameters are less than 7mm. It has some advantage in dissecting. However, it has the shortcomings of the clamp dissector during coagulating. 5. Hand-assisted laparoscopic liver resection can make use of the flexibility and feeling of the operators left hand.

结果:1、钳夹分离切肝法不需特殊仪器设备,只要具备常规的腹腔镜器械即可实施,成本低,肝断面较易渗血;2、微波固化切肝法肝实质出血很少,视野清晰,成本低,操作简单,是一种安全、简便、有效的方法;3、超声刀是目前较为理想的切肝器械,术中出血少,但是,切割速度慢,手术时间长,而且,切割强度有限,适用于无肝硬化的肝切除;4、Ligsure具有挤压粉碎及高频电凝止血两大功能,可使包括7~以下管道的肝组织碳化、形成焦痴,具有一定的优势,但是,也存在分离钳电凝止血的缺点;5、手辅助腹腔镜肝切除可以利用术者左手的灵活性及手感,便于术中显露、分离、控制出血等,可随意协助右手及助手的主要操作,缩短了手术时间,大大提高了腹腔镜肝切除的安全性,李朝龙等的改良方法,同样达到了手辅助目的,又节省了费用;6、小切口腹腔镜辅助切肝法可以使用剖腹肝切除常规器械及剖腹肝切除技术,操作简单、可靠,适用于肝左外叶切除及右肝第V段切除;7、Endo一GIA切肝法在离断肝组织的同时闭合管道结构,多用于肝左静脉、门静脉分支、管径较大胆管的切割,缺点是不能用于较厚肝组织的切割,而且价格昂贵;8、临床巧例腹腔镜肝切除均获得成功,手术时间最短1.5h,最长sh,平均125 min,多数在100 min左右,手术出血量最少50 ml,最多500 ml,平均1 78 ml,除2例合并严重肝硬化的原发性肝癌患者术后出现少量腹水,1例术后发生胆漏外,其余无并发症,发生胆漏的1例患者术后住院40d,多数在术后一周左右出院,术后住院时间5一40d,平均gd。

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