Teramoto Kenichi, Kawamura Tohru, Takamatsu Susumu, Noguchi Norio, Nakamura Noriaki, Arii Shigeki
Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo 113-8519, Japan.
World J Surg. 2003 Oct;27(10):1131-6. doi: 10.1007/s00268-003-6936-5. Epub 2003 Aug 18.
Several trials have been reported examining laparoscopic liver resections for the treatment of various kinds of liver tumors. However, there are no detailed reports on the use of laparoscopic (LH) and thoracoscopic (TH) hepatectomy for the treatment of hepatocellular carcinoma (HCC). Eleven laparoscopic and thoracoscopic partial liver resections were attempted for treating HCC. The indications for performing a laparoscopic or thoracoscopic partial hepatectomy were as follows: (1) the tumor was located on the surface of the liver; (2) the tumor was less than 3 cm in diameter; and (3) the tumor was not located adjacent to any large vessels. A TH was performed if the tumor was located in segment 8; an LH was performed if the tumor was located in segment 3, 4, or 5. Hand-assisted operations were performed in two patients. The mean operating time was 186.1 +/- 44.0 minutes (range 130-310 minutes). The operative blood loss was 218.3 +/- 197.6 ml (range 20-650 ml). The mean postoperative hospital stay was 11.3 +/- 5.7 days (range 7-26 days). Two patients experienced postoperative complications (wound infection and ascites). No local recurrences have occurred to date. The overall 5-year survival rate and disease-free 5-year survival rate were 75.0% and 38.2%, respectively. Laparoscopic and thoracoscopic hepatic resections are less invasive than conventional surgical techniques and are useful for treating HCC in select patients.
已有多项关于腹腔镜肝切除术治疗各种肝肿瘤的试验报道。然而，关于使用腹腔镜（LH）和胸腔镜（TH）肝切除术治疗肝细胞癌（HCC）的详细报道却很少。我们尝试了11例腹腔镜和胸腔镜下部分肝切除术来治疗HCC。进行腹腔镜或胸腔镜下部分肝切除术的指征如下：（1）肿瘤位于肝脏表面；（2）肿瘤直径小于3 cm；（3）肿瘤不位于任何大血管附近。如果肿瘤位于第8段，则进行胸腔镜肝切除术（TH）；如果肿瘤位于第3、4或5段，则进行腹腔镜肝切除术（LH）。两名患者进行了手辅助手术。平均手术时间为186.1±44.0分钟（范围130 - 310分钟）。术中失血量为218.3±197.6 ml（范围20 - 650 ml）。术后平均住院时间为11.3±5.7天（范围7 - 26天）。两名患者出现术后并发症（伤口感染和腹水）。迄今为止未发生局部复发。总体5年生存率和无病5年生存率分别为75.0%和38.2%。腹腔镜和胸腔镜肝切除术比传统手术技术的侵入性小，对特定患者治疗HCC很有用。
