Cho Jai Young, Han Ho-Seong, Yoon Yoo-Seok, Shin Sang-Hyun
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.
Surg Endosc. 2008 Nov;22(11):2344-9. doi: 10.1007/s00464-008-9966-0. Epub 2008 Jun 5.
There is a growing interest in laparoscopic liver resection because of its minimal invasiveness, the increased experience with laparoscopic procedures, and the advances of the laparoscopic devices. The authors describe their experience with laparoscopic liver resection, including its use for lesions in the posterosuperior segments of the liver (segments 1, 7, and 8, and the superior part of segment 4).
A retrospective analysis was performed for the clinical data of 128 patients who underwent laparoscopic liver resection between January 2004 and December 2007. The patients were classified into two groups according to the location of the lesion: the anterolateral (AL) group (n = 92) and the posterosuperior (PS) group (n = 36).
The study enrolled 76 men and 52 women with a mean age of 57 years. The indications for resection were hepatocellular carcinoma (n = 57), hepatolithiasis (n = 39), liver metastasis from colorectal cancer (n = 21), and benign liver tumor (n = 11). There were no differences between the groups in terms of preoperative patient demographic characteristics or indications for liver resection. Major liver resection was performed more frequently for the PS group than for the AL group (p < 0.001). The mean operative time and the rate of intraoperative transfusion were significantly greater in the PS group than in the AL group (p = 0.009 and 0.015, respectively). However, the mean postoperative hospital stay and the complication rate were similar in the two groups (p = 0.345 and 0.733, respectively). Four patients underwent conversion to open hepatectomy (3.1%), with no difference in the rate of conversion between the two groups (p = 0.323). The complication rate was 18%, and all the patients were managed conservatively without the need for additional surgery.
Laparoscopic liver resection, including that for lesions in the posterosuperior part of the liver, is technically feasible and safe.
由于腹腔镜肝切除术具有微创性、腹腔镜手术经验的增加以及腹腔镜设备的进步，人们对其的兴趣日益浓厚。作者描述了他们进行腹腔镜肝切除术的经验，包括其用于肝脏后上段（第1、7和8段以及第4段上部）病变的情况。
对2004年1月至2007年12月期间接受腹腔镜肝切除术的128例患者的临床资料进行回顾性分析。根据病变位置将患者分为两组：前外侧（AL）组（n = 92）和后上（PS）组（n = 36）。
该研究纳入了76名男性和52名女性，平均年龄为57岁。切除指征包括肝细胞癌（n = 57）、肝内胆管结石（n = 39）、结直肠癌肝转移（n = 21）和肝脏良性肿瘤（n = 11）。两组患者术前人口统计学特征或肝切除指征方面无差异。PS组比AL组更频繁地进行大肝切除术（p < 0.001）。PS组的平均手术时间和术中输血率显著高于AL组（分别为p = 0.009和0.015）。然而，两组的平均术后住院时间和并发症发生率相似（分别为p = 0.345和0.733）。4例患者转为开腹肝切除术（3.1%），两组之间的转换率无差异（p = 0.323）。并发症发生率为18%，所有患者均经保守治疗，无需额外手术。
腹腔镜肝切除术，包括用于肝脏后上段病变的手术，在技术上是可行且安全的。
