Kazaryan Airazat M, Pavlik Marangos Irina, Rosseland Arne R, Røsok Bård I, Mala Tom, Villanger Olaug, Mathisen Oystein, Giercksky Karl-Erik, Edwin Bjørn
Interventional Centre, Rikshospitalet University Hospital, Oslo, Norway.
Arch Surg. 2010 Jan;145(1):34-40. doi: 10.1001/archsurg.2009.229.
The introduction of laparoscopic liver resection has been challenging because new and safe surgical techniques have had to be developed, and skepticism remains about the use of laparoscopy for malignant neoplasms. We present herein a large-volume single-center experience with laparoscopic liver resection.
Retrospective study.
Rikshospitalet University Hospital.
One hundred thirty-nine patients who underwent 177 laparoscopic liver resections in 149 procedures from August 18, 1998, through October 14, 2008. One hundred thirteen patients had malignant lesions, of whom 96 had colorectal metastases.
Laparoscopic liver resection for malignant and benign lesions.
Perioperative and oncologic outcomes and survival.
Five procedures (3.4%) were converted to laparotomy and 1 (0.7%) to laparoscopic radiofrequency ablation. The remaining 143 procedures were completed laparoscopically, during which 177 liver resections were undertaken, including 131 nonanatomic and 46 anatomic resections. The median operative time and blood loss were 164 (50-488) minutes and 350 (<50-4000) mL, respectively. There were 10 intraoperative (6.7%) and 18 postoperative (12.6%) complications. One patient (0.7%) died. The median postoperative stay and opioid requirement were 3 (1-42) and 1 (0-11) days, respectively. Tumor-free resection margins determined by histopathologic evaluation were achieved in 140 of 149 malignant specimens (94.0%). The 5-year actuarial survival for patients undergoing procedures for colorectal metastases was 46%.
In experienced hands, laparoscopic liver resection is a favorable alternative to open resection. Perioperative morbidity and mortality and long-term survival after laparoscopic resection of colorectal metastases appear to be comparable to those after open resections.
腹腔镜肝切除术的引入具有挑战性，因为必须开发新的安全手术技术，并且对于腹腔镜在恶性肿瘤中的应用仍存在怀疑。我们在此展示了一项关于腹腔镜肝切除术的大容量单中心经验。
回顾性研究。
里克斯医院大学医院。
1998年8月18日至2008年10月14日期间，139例患者接受了149例手术中的177例腹腔镜肝切除术。113例患者有恶性病变，其中96例有结直肠转移。
对恶性和良性病变进行腹腔镜肝切除术。
围手术期和肿瘤学结局及生存率。
5例手术（3.4%）转为开腹手术，1例（0.7%）转为腹腔镜射频消融术。其余143例手术通过腹腔镜完成，在此期间进行了177例肝切除术，包括131例非解剖性切除和46例解剖性切除。中位手术时间和失血量分别为164（50 - 488）分钟和350（<50 - 4000）毫升。有10例术中并发症（6.7%）和18例术后并发症（12.6%）。1例患者（0.7%）死亡。中位术后住院时间和阿片类药物需求量分别为3（1 - 42）天和1（0 - 11）天。149例恶性标本中有140例（94.0%）通过组织病理学评估实现了无瘤切缘。接受结直肠转移手术患者的5年精算生存率为46%。
在经验丰富的医生手中，腹腔镜肝切除术是开腹切除术的一种有利替代方法。腹腔镜切除结直肠转移瘤后的围手术期发病率、死亡率和长期生存率似乎与开腹切除术后相当。
