Abdel-Atty M Y, Farges O, Jagot P, Belghiti J
Department of Hepato-biliary and Digestive Surgery, Beaujon Hospital, University Paris VII, Clichy, France.
Br J Surg. 1999 Nov;86(11):1397-400. doi: 10.1046/j.1365-2168.1999.01283.x.
Clinical or biological evidence of liver failure is usually considered a contraindication to open liver surgery as it is associated with a prohibitive risk of postoperative death.
This report describes three patients who had resection of a superficial hepatocellular carcinoma suspected either to be ruptured, or at high risk of rupture, using the laparoscopic approach. All three patients had intractable ascites, in two superimposed on active hepatitis. Surgery was per- formed under continuous carbon dioxide pneumoperitoneum with intermittent clamping of the hepatic pedicle.
Intraoperative blood loss was between 100 and 400 ml; no blood transfusion was required. The postoperative course was uneventful except for a transient leak of ascites through the trocar wounds. Duration of in-hospital stay was 6-10 days. Liver function tests had returned to preoperative values within 1 month of surgery in all patients.
The laparoscopic approach may enable liver resection in patients with cirrhosis and evidence of liver failure that would contraindicate open surgery.
肝衰竭的临床或生物学证据通常被视为开放性肝脏手术的禁忌证，因为其与术后死亡风险过高相关。
本报告描述了3例使用腹腔镜方法切除疑似破裂或有高破裂风险的浅表肝细胞癌的患者。所有3例患者均有顽固性腹水，其中2例合并活动性肝炎。手术在持续二氧化碳气腹并间歇性阻断肝蒂的情况下进行。
术中失血量在100至400毫升之间；无需输血。除了穿刺孔伤口有短暂腹水渗漏外，术后过程顺利。住院时间为6至10天。所有患者的肝功能检查在术后1个月内恢复到术前值。
腹腔镜方法可能使有肝硬化且有肝衰竭证据（这些证据会使开放性手术成为禁忌）的患者能够进行肝切除。
