Poon Ronnie T
Department of Surgery, University of Hong Kong, Hong Kong, China.
Surg Technol Int. 2007;16:73-81.
The use of laparoscopic surgery in managing liver malignancies has been developed only recently because of the complexity of liver surgery. Diagnostic laparoscopy is useful in staging liver malignancies before resection. The need for laparoscopic staging of colorectal liver metastasis has diminished as a result of better imaging technology such as positron emission tomography (PET). Laparoscopy still plays an important role in the staging of hepatocellular carcinoma because of the high incidences of multifocal tumors and venous invasion. Recently, laparoscopic liver resection was possible with the availability of new instruments that allow relatively bloodless liver transection. Small series have reported a conversion rate of 10% to 20%, and the complication rate and transfusion rate appeared to be comparable with open surgery in a few retrospective case-control studies. Limited data also suggest that oncological clearance and long-term outcome were not compromised. However, the role of laparoscopic liver resection is confined mainly to wedge or segmental resection of anterior segments of the right lobe and left lateral segments. Although successful laparoscopic hemihepatectomy and resections of segments VII and VIII have been reported at the time of this writing, these should be attempted only in centers that have already acquired wide experience with laparoscopic liver resection. Another application of laparoscopic surgery for the management of liver malignancies is laparoscopic radiofrequency ablation, which is gaining popularity because of its well-documented safety and efficacy. With further developments in technology, that laparoscopic surgery will have a greater impact on the management of liver malignancies is foreseeable in the near future.
由于肝脏手术的复杂性，腹腔镜手术在肝脏恶性肿瘤治疗中的应用直到最近才得以发展。诊断性腹腔镜检查在肝恶性肿瘤切除术前的分期中很有用。由于正电子发射断层扫描（PET）等更好的成像技术，结直肠癌肝转移的腹腔镜分期需求有所减少。由于多灶性肿瘤和静脉侵犯的发生率较高，腹腔镜检查在肝细胞癌的分期中仍发挥着重要作用。最近，随着新器械的出现，腹腔镜肝切除术成为可能，这些器械可实现相对无血的肝实质离断。少数研究报道中转开腹率为10%至20%，在一些回顾性病例对照研究中，并发症发生率和输血率似乎与开放手术相当。有限的数据还表明，肿瘤学切缘和长期预后并未受到影响。然而，腹腔镜肝切除术的作用主要局限于右叶前段和左外叶的楔形或节段性切除。尽管在撰写本文时已有成功的腹腔镜半肝切除术以及Ⅶ、Ⅷ段切除术的报道，但这些手术仅应在已经积累了丰富腹腔镜肝切除经验的中心尝试开展。腹腔镜手术在肝脏恶性肿瘤治疗中的另一应用是腹腔镜射频消融，因其安全性和有效性已得到充分证明而越来越受欢迎。随着技术的进一步发展，腹腔镜手术在不久的将来对肝脏恶性肿瘤治疗产生更大影响是可以预见的。
