Vibert E, Perniceni T, Levard H, Denet C, Shahri N K, Gayet B
Department of Digestive Diseases, Montsouris Institute, University Paris V, 42 Boulevard Jourdan, 75014 Paris, France.
Br J Surg. 2006 Jan;93(1):67-72. doi: 10.1002/bjs.5150.
This paper describes a 10-year experience of laparoscopic liver surgery, including several major hepatectomies for malignant tumours.
Of 243 hepatectomies carried out between January 1995 and December 2004, 113 (46.5 per cent) were performed by laparoscopy and 89 were included in this retrospective study.
Twenty-four laparoscopic hepatectomies (27 per cent) were for benign disease and 65 (73 per cent) for malignant tumours, including hepatocellular carcinoma (HCC) in 16 patients and colorectal metastasis (CRM) in 41. Minor hepatectomy was performed in 51 patients and major hepatectomy (three or more Couinaud segments) in 38. Conversion to laparotomy was necessary in 12 patients and perioperative blood transfusion in eight. One patient with cirrhosis who underwent right hepatectomy for HCC with conversion to open surgery died 8 days after surgery. Major morbidity occurred in eight patients (16 per cent) having minor hepatectomy and in 11 (29 per cent) of those having a major resection. The 3-year overall and disease-free survival rates for patients with CRM (mean follow-up 30 months) were 87 (11 patients at risk) and 51 (6 patients at risk) per cent respectively. Corresponding values for patients with HCC (mean follow-up 40 months) were 85 (10 patients at risk) and 68 (5 patients at risk) per cent.
In experienced hands, the results of laparoscopic liver surgery are similar to those for laparotomy.
本文描述了10年的腹腔镜肝脏手术经验，包括几例针对恶性肿瘤的大型肝切除术。
在1995年1月至2004年12月期间实施的243例肝切除术中，113例（46.5%）通过腹腔镜进行，本回顾性研究纳入了其中89例。
24例（27%）腹腔镜肝切除术用于良性疾病，65例（73%）用于恶性肿瘤，其中16例为肝细胞癌（HCC），41例为结直肠癌转移（CRM）。51例患者实施了小范围肝切除术，38例实施了大范围肝切除术（切除三个或更多Couinaud肝段）。12例患者需要转为开腹手术，8例患者术中需要输血。1例因HCC接受右肝切除术并转为开放手术的肝硬化患者术后8天死亡。小范围肝切除术患者中有8例（16%）发生严重并发症，大范围肝切除术患者中有11例（29%）发生严重并发症。CRM患者（平均随访30个月）的3年总生存率和无病生存率分别为87%（11例处于风险中）和51%（6例处于风险中）。HCC患者（平均随访40个月）的相应数值分别为85%（10例处于风险中）和68%（5例处于风险中）。
在经验丰富的医生手中，腹腔镜肝脏手术的结果与开腹手术相似。
