Makdissi Fabio F, Surjan Rodrigo C T, Machado Marcel Autran C
Department of Gastroenterology, University of São Paulo, São Paulo, Brazil.
J Surg Oncol. 2009 Mar 1;99(3):166-8. doi: 10.1002/jso.21206.
Enucleation of small lesions located near the hepatic surface can be achieved with low morbidity and mortality. This article describes a simple laparoscopic technique for enucleation of liver tumors.
After inspection and intraoperative ultrasonography, Glisson's capsule is marked with eletrocautery 2 cm away from the tumor margin. Ultrasonography is used to ascertain surgical margin right before liver transection. Hemihepatic ischemia is applied and marked area is anchored by stitches. The suture is held together by metallic clips and upward traction is performed, facilitating the transection of the parenchyma and correct identification of vascular and biliary structures.
This technique has been successfully employed in six consecutive patients. There were four men and two women, mean age 50.3 years. Four patients underwent liver resection for malignant disease and two for benign liver neoplasm. Pathologic surgical margins were free in all cases and mean hospital stay was 2 days. No postoperative mortality was observed.
This technique may facilitate laparoscopic nonanatomical liver resection and reduce risk of positive surgical margins. It is also useful in combination with anatomical laparoscopic liver resections such as right or left hemihepatectomies in patients with bilateral liver tumors as occurred in one of our patients.
位于肝表面附近的小病灶摘除术可实现较低的发病率和死亡率。本文描述了一种简单的腹腔镜肝肿瘤摘除技术。
经检查及术中超声检查后，在距肿瘤边缘2 cm处用电灼标记肝门部结缔组织被膜。在肝实质离断前，用超声检查确定手术切缘。采用半肝血流阻断，并用缝线固定标记区域。缝线用金属夹固定在一起，并向上牵引，便于肝实质离断及正确识别血管和胆管结构。
该技术已连续成功应用于6例患者。其中男性4例，女性2例，平均年龄50.3岁。4例患者因恶性疾病行肝切除术，2例因良性肝肿瘤行肝切除术。所有病例手术切缘病理均为阴性，平均住院时间为2天。未观察到术后死亡病例。
该技术可能有助于腹腔镜非解剖性肝切除术，并降低手术切缘阳性的风险。在双侧肝肿瘤患者（如我们的1例患者）中，该技术与解剖性腹腔镜肝切除术（如右半肝切除术或左半肝切除术）联合应用也很有用。
