Dagher Ibrahim, O'Rourke Nicholas, Geller David A, Cherqui Daniel, Belli Giulio, Gamblin T Clark, Lainas Panagiotis, Laurent Alexis, Nguyen Kevin Tri, Marvin Michael R, Thomas Mark, Ravindra Kadyalia, Fielding George, Franco Dominique, Buell Joseph F
Department of Surgery, Antoine Béclère Hospital, 157 rue de la Porte de Trivaux, 92141 Clamart cedex, France.
Ann Surg. 2009 Nov;250(5):856-60. doi: 10.1097/SLA.0b013e3181bcaf46.
To analyze the results of 6 international surgical centers performing laparoscopic major liver resections.
The safety and feasibility of laparoscopy for minor liver resections has been previously demonstrated. Major anatomic liver resections, initially considered to be unsuitable for laparoscopy, are increasingly reported by several centers worldwide.
Prospective databases of 3 European, 2 U.S., and 1 Australian centers were combined. Between 1997 and 2008, 210 major liver resections were performed: 136 right and 74 left hepatectomies. Results and differences in surgical techniques between the 6 centers are outlined.
Surgical duration was 250 minutes (range: 90-655 minutes). Operative blood loss was 300 mL (range: 20-2500 mL). Thirty patients (14.3%) received blood transfusion. Conversion to open surgery was required in 26 patients (12.4%). Portal triad clamping was performed in 24 patients (11.4%). Median tumor size was 5.4 cm (range: 1-25 cm) and surgical margin was 10.5 mm (range: 0-70 mm). Two patients died during the postoperative period from pulmonary embolism and urosepsis. Liver-specific and general complications occurred in 17 (8.1%) and 29 patients (13.8%), respectively. Hospital length of stay was 6 days (range: 1-34 days). A further analysis of early (n = 90) and late (n = 120) experience showed improved surgical and postoperative results in the latter group.
This multicenter study demonstrates that laparoscopic major liver resections are feasible in selected patients and results improve with experience. However, proficiency in both open liver surgery and advanced laparoscopy is compulsory and surgeons must begin with minor laparoscopic resections.
分析6家国际外科中心进行腹腔镜下肝大部切除术的结果。
先前已证实腹腔镜下肝小部切除术的安全性和可行性。最初被认为不适合腹腔镜手术的肝大部解剖性切除术，全球多个中心越来越多地报道。
合并了3家欧洲、2家美国和1家澳大利亚中心的前瞻性数据库。1997年至2008年期间，共进行了210例肝大部切除术：136例右半肝切除术和74例左半肝切除术。概述了6个中心之间的手术结果和手术技术差异。
手术时间为250分钟（范围：90 - 655分钟）。术中失血300毫升（范围：20 - 2500毫升）。30例患者（14.3%）接受了输血。26例患者（12.4%）需要转为开腹手术。24例患者（11.4%）进行了肝门三联阻断。肿瘤中位大小为5.4厘米（范围：1 - 25厘米），手术切缘为10.5毫米（范围：0 - 70毫米）。2例患者术后死于肺栓塞和尿脓毒症。肝特异性并发症和一般并发症分别发生在17例（8.1%）和29例患者（13.8%）中。住院时间为6天（范围：1 - 34天）。对早期（n = 90）和晚期（n = 120）经验的进一步分析显示，后一组的手术和术后结果有所改善。
这项多中心研究表明，腹腔镜下肝大部切除术在选定患者中是可行的，且结果会随着经验的积累而改善。然而，必须精通开腹肝手术和高级腹腔镜技术，外科医生必须从腹腔镜下小部切除术开始。
