Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
Ann Surg. 2010 Mar;251(3):450-3. doi: 10.1097/SLA.0b013e3181cf87da.
To assess the feasibility, safety, and short-term outcomes of laparoscopy-assisted major liver resections.
The number of reports of laparoscopic major hepatectomies has gradually increased, and living donor hepatectomies for liver transplant have also recently been performed. However, because of the high degree of proficiency required, major hepatectomies have not been widespread. We developed an original procedure in which the liver is mobilized laparoscopically and resected by a hanging technique through a small incision.
Between November 2002 and December 2008, 43 patients underwent laparoscopy-assisted major liver resections (LAMLRs) in our institution for hepatocellular carcinoma, metastatic liver cancer, and benign diseases.
LAMLRs were completed for 42 patients (97.7%). The median age was 62 years (range: 24-83 years). Preoperative diagnoses were hepatocellular carcinoma (n = 15), metastatic liver cancer (n = 19), and benign disease (n = 8). The types of liver resection consisted of the following: right trisectionectomy (n = 2), right hepatectomy (n = 14), left hepatectomy (n = 16), trisegmentectomy 4, 5, 8 (n = 2), right anterior sectionectomy (n = 4), and extended right posterior sectionectomy (n = 4). The median operating time was 317 minutes (range: 192-542 minutes) and median blood loss was 631 mL (range: 68-2785 mL). There were neither perioperative deaths nor reoperations. Five patients (11.9%) experienced postoperative complications, 2 patients (4.8%) showed bile leakage, and 3 patients (7.1%) developed wound infections. The median postoperative hospital stay was 13.5 days (range: 6-154 days).
LAMLR with the hanging technique can be completed safely. The procedure can be performed by open liver surgeons; and thus may be widely performed in the future.
评估腹腔镜辅助大肝切除术的可行性、安全性和短期结果。
腹腔镜辅助大肝切除术的报道逐渐增多，活体供肝肝移植也已完成。然而，由于需要高度熟练程度，大肝切除术尚未广泛开展。我们开发了一种原创手术方法，通过腹腔镜游离肝脏，并通过小切口进行悬垂技术切除。
2002 年 11 月至 2008 年 12 月，我院对 43 例肝细胞癌、转移性肝癌和良性疾病患者行腹腔镜辅助大肝切除术（LAMLR）。
42 例（97.7%）患者完成 LAMLR。中位年龄 62 岁（范围：24-83 岁）。术前诊断为肝细胞癌（n=15）、转移性肝癌（n=19）和良性疾病（n=8）。肝切除术类型包括：右三叶切除术（n=2）、右半肝切除术（n=14）、左半肝切除术（n=16）、4、5、8 段切除术（n=2）、右前叶切除术（n=4）和右后叶扩展切除术（n=4）。中位手术时间 317 分钟（范围：192-542 分钟），中位出血量 631 毫升（范围：68-2785 毫升）。无围手术期死亡或再次手术。5 例（11.9%）患者发生术后并发症，2 例（4.8%）发生胆漏，3 例（7.1%）发生伤口感染。中位术后住院时间为 13.5 天（范围：6-154 天）。
采用悬挂技术的腹腔镜辅助大肝切除术是安全的。该手术可以由开腹肝外科医生完成，因此未来可能会广泛开展。
