Institute of Minimally Invasive Surgery, Zhejiang University, Hangzhou, 310016, China.
Surg Endosc. 2009 Nov;23(11):2556-62. doi: 10.1007/s00464-009-0454-y. Epub 2009 Apr 4.
Laparoscopic liver resection was performed at some institutes. The procedure mainly included local resection, segmentectomy, and left lateral segmentectomy. With experience accumulation and technique innovation, laparoscopic left hemihepatectomy was performed in selected patients. This study was designed to introduce and evaluate the safety and feasibility of this procedure.
Nineteen successive patients underwent laparoscopic left hemihepatectomy from 2005 to 2007. They were compared by the matched-pair method with 19 other patients who underwent conventional open left hemihepatectomy. Surgical feature, postoperative course, and the learning curve of laparoscopic left hemihepatectomy were studied.
Laparoscopic hemihepatectomy was successfully performed in 17 cases. Two conversions were required. Compared with the open group, the blood loss was significantly less in the laparoscopic group (462 +/- 372 vs. 895 +/- 704, p = 0.03). Postoperative hospital stay of the laparoscopic group was shorter but not significant compared with the open group (9 +/- 5 vs. 13 +/- 7, p = 0.086). Postoperative albumin level in the laparoscopic group was significantly higher than the open group (33 +/- 4.8 vs. 27.6 +/- 3.2, p = 0.001). There was no perioperative mortality in either group. Two complications occurred in the laparoscopic group (11%) and four in the open group (21%). A tendency of gradually decreased transecting time was noticed in the early cases (R(2) = 0.676; p = 0.012).
Laparoscopic left hemihepatectomy is a safe and feasible procedure for select patients.
一些机构已经开展腹腔镜肝切除术。该术式主要包括局部切除术、节段切除术和左外侧叶切除术。随着经验的积累和技术创新，在选择的患者中开展了腹腔镜左半肝切除术。本研究旨在介绍和评估该术式的安全性和可行性。
2005 年至 2007 年，19 例连续患者接受了腹腔镜左半肝切除术，通过配对法与 19 例行传统开腹左半肝切除术的患者进行比较。研究了手术特点、术后过程和腹腔镜左半肝切除术的学习曲线。
腹腔镜肝切除术在 17 例中成功完成，其中 2 例中转开腹。与开腹组相比，腹腔镜组的出血量明显减少（462±372 比 895±704，p=0.03）。与开腹组相比，腹腔镜组的术后住院时间虽较短但差异无统计学意义（9±5 比 13±7，p=0.086）。腹腔镜组术后白蛋白水平明显高于开腹组（33±4.8 比 27.6±3.2，p=0.001）。两组均无围手术期死亡。腹腔镜组有 2 例并发症（11%），开腹组有 4 例（21%）。在早期病例中，可见横断时间逐渐减少的趋势（R²=0.676；p=0.012）。
对于选择的患者，腹腔镜左半肝切除术是一种安全可行的术式。
