Nazih Zuhdi Transplant Institute, INTEGRIS Baptist Medical Center, 3300 NW Expressway, Oklahoma City, Oklahoma 73112, USA.
Hepatobiliary Pancreat Dis Int. 2011 Feb;10(1):38-42. doi: 10.1016/s1499-3872(11)60005-2.
Laparoscopic liver resection is one of the most complex procedures in hepatobiliary surgery. In the last two decades, laparoscopic liver surgery has emerged as an option at major academic institutions. The purpose of this study is to describe the initial experience of minimally invasive liver resections at a non-academic institution.
We retrospectively reviewed medical records of patients undergoing laparoscopic liver resections between June 2006 and December 2009 at our center. Indications, technical aspects, and outcomes of these patients are described.
Laparoscopic liver resection was attempted in 28 patients. Of these, 27 patients underwent laparoscopic liver resection (22 total laparoscopic and 5 hand assisted) and one needed conversion to open surgery. Twenty patients had a benign lesion and 8 had malignant lesions. Three patients had multiple lesions in different segments requiring separate resections. The lesions were located in segments II-III (n=18), IV (n=3), V-VI (n=9), and VII (n=1). Tumor size ranged from 1.5 cm to 8.5 cm. The surgical procedures included left lateral sectionectomy (n=17), left hepatectomy (n=2), sectionectomy (n=8), and local resections (n=4). Median operative time was 110 minutes (range 55-210 minutes), and the median length of hospital stay was 2.5 days (range 1-7 days). There was no perioperative mortality. One patient developed hernia at the site of tumor extraction requiring repair at 3 months.
Laparoscopic liver resections can be safely performed in selected patients with benign and malignant liver tumors. With increasing experience, laparoscopic liver resections are likely to become a favorable alternative to open resection.
腹腔镜肝切除术是肝胆外科最复杂的手术之一。在过去的二十年中，腹腔镜肝手术已成为主要学术机构的选择。本研究的目的是描述在非学术机构进行微创肝切除术的初步经验。
我们回顾性分析了 2006 年 6 月至 2009 年 12 月期间在我们中心接受腹腔镜肝切除术的患者的病历。描述了这些患者的适应证、技术方面和结果。
尝试了 28 例腹腔镜肝切除术。其中，27 例患者接受了腹腔镜肝切除术（22 例全腹腔镜和 5 例手助），1 例需要转为开放手术。20 例为良性病变，8 例为恶性病变。3 例患者有多个不同节段的病变需要分别切除。病变位于 II-III 段（n=18）、IV 段（n=3）、V-VI 段（n=9）和 VII 段（n=1）。肿瘤大小从 1.5 厘米到 8.5 厘米不等。手术包括左外侧叶切除术（n=17）、左半肝切除术（n=2）、节段切除术（n=8）和局部切除术（n=4）。中位手术时间为 110 分钟（范围 55-210 分钟），中位住院时间为 2.5 天（范围 1-7 天）。无围手术期死亡。1 例患者在肿瘤切除部位出现疝，需要在 3 个月时修复。
在选择的良性和恶性肝肿瘤患者中，腹腔镜肝切除术可以安全进行。随着经验的增加，腹腔镜肝切除术可能成为开放切除术的有利替代方法。
