Department of Surgery, UPMC Liver Cancer Center, Starzl Transplant Institute, University of Pittsburgh, 3459 Fifth Avenue, UPMC Montefiore-7 South, Pittsburgh, PA 15213, USA.
World J Surg. 2011 Jul;35(7):1478-86. doi: 10.1007/s00268-010-0906-5.
More than 3,000 laparoscopic liver resections (LLR) are performed worldwide for benign disease, malignancy, and living donor hepatectomy. Minimally invasive hepatic resection approaches include pure laparoscopic, hand-assisted laparoscopic, and a laparoscopic-assisted open "hybrid" approach, where the operation is started laparoscopically to mobilize the liver and begin the dissection, followed by a small laparotomy for completion of the parenchymal transection. Surgeons should have an advanced understanding of hepatic anatomy, extensive experience in open liver surgery, and technical skill to control major vascular and biliary structures laparoscopically before embarking on LLR. Although there is no absolute size criterion, smaller, peripheral lesions (<5 cm) that lie far from major vessels and anticipated transection planes are most amenable to LLR. Although the majority of reported LLR are non-anatomic resections or segmentectomies, several surgical groups are now performing laparoscopic major hepatic resections with excellent safety profiles. Patient benefits from LLR include less operative blood loss, less postoperative pain and narcotic requirement, and a shorter length of hospital stay, with comparable postoperative morbidity and mortality to open liver resection. Comparison studies between LLR and open resection have revealed no differences in width of resection margins for malignant lesions or overall survival after resection for hepatocellular cancer or colorectal cancer liver metastases. Advantages of LLR for HCC in particular include avoidance of collateral vessel ligation, decreased postoperative hepatic insufficiency, and fewer postoperative adhesions, all of which are features that enhance subsequent liver transplantation.
全世界已经完成了超过 3000 例腹腔镜肝切除术（LLR），用于治疗良性疾病、恶性肿瘤和活体供肝切除术。微创肝切除方法包括纯腹腔镜、手助腹腔镜和腹腔镜辅助开腹“杂交”方法，手术开始时采用腹腔镜以游离肝脏并开始解剖，然后进行小切口完成实质切开。外科医生应深入了解肝脏解剖结构，具有丰富的开腹肝手术经验，并具备在开始 LLR 之前控制主要血管和胆道结构的腹腔镜技术技能。虽然没有绝对的大小标准，但较小的、远离主要血管和预期的肝段平面的外周病变（<5cm）最适合进行 LLR。虽然大多数报道的 LLR 是非解剖性切除术或节段切除术，但现在有几个外科小组正在进行腹腔镜肝叶切除术，具有出色的安全性。LLR 的患者获益包括手术出血量减少、术后疼痛和阿片类药物需求减少、住院时间缩短，与开腹肝切除术相比，术后发病率和死亡率相当。LLR 与开腹切除术的比较研究显示，对于肝癌或结直肠癌肝转移的恶性肿瘤，LLR 的切缘宽度或术后总生存率没有差异。LLR 对 HCC 的特别优势包括避免侧支血管结扎、减少术后肝功能不全和术后粘连减少，所有这些都有助于提高后续肝移植的效果。
