Weber Thomas, Sendt Wolfgang, Scheele Johannes
Department of Thoracic Surgery, University Hospital, Bern, Switzerland.
J Laparoendosc Adv Surg Tech A. 2004 Feb;14(1):37-42. doi: 10.1089/109264204322862342.
The laparoscopic accessibility of congenital liver cysts located in the anterosuperior (VIII) and posterosuperior (VII) segments has been questioned for some time. In support of the laparoscopic approach, we here describe our minimally invasive technique in two patients with solitary congenital cysts located in the apex of liver segments VIII and VII, respectively.
Both patients were placed in the inverted Y position. Four trocars were used, their position depending on the location of the cyst.
The segment VIII cyst was easily reached via this anterior approach, while the segment VII cyst required significant mobilization of the right liver lobe. In both cases a complete excision of the cystic roof was achieved using the harmonic scalpel. Without performing an omentoplasty no recurrences were observed after 20 and 28 months, respectively.
Solitary cysts located in segments VII and VIII of the liver can be safely treated by laparoscopic unroofing. Cyst recurrences may best be prevented by a complete excision of the cystic roof with an adjacent rim of hepatic parenchyma.
位于肝前上（Ⅷ）段和后上（Ⅶ）段的先天性肝囊肿的腹腔镜手术可及性在一段时间内一直受到质疑。为支持腹腔镜手术方法，我们在此描述了分别对两名患有位于肝Ⅷ段和Ⅶ段顶端的孤立性先天性囊肿患者采用的微创技术。
两名患者均采用倒Y体位。使用了四个套管针，其位置取决于囊肿的位置。
通过这种前路方法很容易到达Ⅷ段囊肿，而Ⅶ段囊肿则需要对右肝叶进行大量游离。在这两例病例中，均使用超声刀完全切除了囊肿顶部。未进行网膜成形术，分别在20个月和28个月后未观察到复发。
位于肝Ⅶ段和Ⅷ段的孤立性囊肿可通过腹腔镜去顶术安全治疗。通过完全切除囊肿顶部及相邻的肝实质边缘，可能最好地预防囊肿复发。
