Otsuka Yuichiro, Tsuchiya Masaru, Maeda Tetsuya, Katagiri Toshio, Isii Jun, Tamura Akira, Yamazaki Kunihiro, Kubota Yoshihisa, Suzuki Takashi, Suzuki Takayuki, Kagami Satoru, Kaneko Hironori
Division of General and Gastroenterological Surgery, Department of Surgery (Omori), Toho University School of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(6):720-5. doi: 10.1007/s00534-009-0139-x. Epub 2009 Aug 4.
BACKGROUND/PURPOSE: We draw on our experience with laparoscopic hepatectomy (LH) to present recommendations for standardization of LH for the treatment of liver tumors.
At our center, 90 LHs were performed from April 1993 to January 2008. These were divided equally into early cases and late cases, and short-term postoperative results were compared. Forty-nine of the LH procedures were total-laparoscopic procedures, 16 were hand-assisted procedures, and 25 were laparoscopy-assisted procedures. The tumors were malignant in 76 cases and benign in 14 cases.
Among late cases, the numbers of malignant tumors and tumors located in the posterosuperior region of the liver (Segments VII, VIII, and IVb) were significantly higher than among early cases; however, operative blood loss and postoperative hospital stay were significantly lower in the late cases (158.9 +/- 213.4 vs. 377.6 +/- 421.2 cc, P = 0.007; and 8.7 +/- 3.6 vs. 15.3 +/- 8.7 days, P = 0.0001, respectively). No operative deaths occurred in either group.
Although LH does have a steep learning curve, we believe that it can be standardized and provide a less invasive surgical option--with no reduction in disease curability--for the treatment of liver tumors in selected patients.
背景/目的：我们借鉴腹腔镜肝切除术（LH）的经验，提出LH治疗肝肿瘤的标准化建议。
在我们中心，1993年4月至2008年1月期间进行了90例LH手术。这些病例被平均分为早期病例和晚期病例，并比较术后短期结果。其中49例LH手术为全腹腔镜手术，16例为手辅助手术，25例为腹腔镜辅助手术。76例肿瘤为恶性，14例为良性。
在晚期病例中，恶性肿瘤数量以及位于肝脏后上区域（Ⅶ、Ⅷ和Ⅳb段）的肿瘤数量显著高于早期病例；然而，晚期病例的术中失血量和术后住院时间显著更低（分别为158.9±213.4 vs. 377.6±421.2 cc，P = 0.007；以及8.7±3.6 vs. 15.3±8.7天，P = 0.0001）。两组均未发生手术死亡。
尽管LH确实有陡峭的学习曲线，但我们认为它可以标准化，并为选定患者的肝肿瘤治疗提供一种侵入性较小的手术选择，且不降低疾病治愈率。
