Lai I-Rue, Yeh Chi-Chuan, Yu Sen-Chang
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung San South Road, Taipei, Taiwan.
Hepatogastroenterology. 2009 Jul-Aug;56(93):1082-5.
BACKGROUND/AIMS: Laparoscopic hepatectomy (LH) has gained increased acceptance for the treatment of selected hepatocellular carcinoma (HCC). The technical consideration and long-term follow-up data of LH for hepatocellular carcinoma are limited. The current study presents the experience of 17 LH for HCC with a mean follow-up of 23 months.
From April 2003 to December 2005, we successfully performed 17 LH for patients with HCC. Patient demographics, peri-operative parameters and outcomes of the 17 patients were assessed retrospectively.
All 17 LH were performed smoothly without conversion to laparotomy. There was no operative mortality, but transfusion and relaparoscopy was required for one patient with internal bleeding 7 days after LH. The mean hospital stay was 10.9 (6-23) days. All but one patient had section margins longer than 1 centimeter. Four patients had tumor thrombi in portal vessels of their resected specimen. During the mean follow up of 23 months, five patients (29.4%) developed recurrence. Four of the recurrences limited in the liver, and one patient had both liver and lung metastasis. No port site or peritoneal metastases were observed. Treatment of recurrence was second resection in one patients and trans-arterial embolization therapy in four other patients. Mean disease-free survival was 19 months.
Laparoscopic hepatectomy is feasible in selected patients with single, smaller and peripherally-located hepatocellular carcinoma. The surgical morbidity and intermediate followup results seem satisfactory.
背景/目的：腹腔镜肝切除术（LH）在治疗特定肝细胞癌（HCC）方面已获得越来越多的认可。关于LH治疗肝细胞癌的技术考量和长期随访数据有限。本研究介绍了17例LH治疗HCC的经验，平均随访时间为23个月。
2003年4月至2005年12月，我们成功地为HCC患者实施了17例LH。对这17例患者的人口统计学资料、围手术期参数和结果进行了回顾性评估。
所有17例LH均顺利完成且未中转开腹。无手术死亡病例，但有1例患者在LH术后7天因内出血需要输血和再次腹腔镜检查。平均住院时间为10.9（6 - 23）天。除1例患者外，所有患者的切缘均超过1厘米。4例患者切除标本的门静脉中有癌栓。在平均23个月的随访期间，5例患者（29.4%）出现复发。其中4例复发局限于肝脏，1例患者出现肝肺转移。未观察到端口部位或腹膜转移。复发患者的治疗为1例再次切除，另外4例接受经动脉栓塞治疗。平均无病生存期为19个月。
腹腔镜肝切除术对于选择的单发、较小且位于周边的肝细胞癌患者是可行的。手术并发症和中期随访结果似乎令人满意。
