Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.
World J Surg. 2011 Jun;35(6):1333-9. doi: 10.1007/s00268-011-1073-z.
The liver is the organ where tumors most frequently metastasize. Hepatic recurrence after resection of hepatocellular carcinoma also occasionally occurs. With the increasing use of laparoscopic surgery for hepatic tumors, there may be a high probability that laparoscopic liver resection can be performed in patients with a surgical history. The purpose of this study was to assess the feasibility and clinical outcomes of laparoscopic liver resection in patients a history of upper abdominal surgery.
Of 202 laparoscopic liver resections, 47 patients underwent laparoscopic liver resection after previous upper abdominal surgery between January 2004 and July 2009. Fifty-five previous surgeries were performed in the 47 patients. The previous types of surgical procedures included hepatobiliary and pancreatic (HPB) procedures (n=25) and non-HPB procedures (colorectal malignancies, subtotal gastrectomy, and splenectomy; n=22).
In patients with a history of surgery, the mean operative time for laparoscopic liver resection was 312.3 min and the mean blood loss was 481.0 ml. In 42 patients (89.4%), there were severe adhesions in the hepatoduodenal ligament and hilar areas. Transfusion was required in 7 patients (14.9%). There was one conversion to a laparotomy due to severe adhesions. Complications occurred in 11 patients (23.4%) and the mean hospital stay was 10.6 days. When we compare patients with and without a history of surgery, there were no differences in the above-mentioned perioperative results. However, among patients with a history of surgery, patients who underwent HPB procedures had longer operative times and higher postoperative morbidities than those who had not undergone HPB procedures.
Laparoscopic liver resection in patients with a history of upper abdominal surgery is feasible and safe.
肝脏是肿瘤最常转移的器官。肝癌切除术后肝复发也偶有发生。随着腹腔镜手术在肝肿瘤中的应用越来越多，对于有手术史的患者，腹腔镜肝切除术很可能成为首选。本研究旨在评估既往上腹部手术患者行腹腔镜肝切除术的可行性和临床效果。
在 202 例腹腔镜肝切除术中，47 例患者于 2004 年 1 月至 2009 年 7 月期间行既往上腹部手术后再次接受腹腔镜肝切除术。47 例患者中共有 55 次既往手术史，既往手术类型包括肝胆胰（HPB）手术（n=25）和非 HPB 手术（结直肠癌、胃大部切除术和脾切除术；n=22）。
在有手术史的患者中，腹腔镜肝切除术的平均手术时间为 312.3 分钟，平均出血量为 481.0 毫升。42 例（89.4%）患者肝十二指肠韧带和肝门区有严重粘连。7 例（14.9%）患者需要输血。由于严重粘连，有 1 例中转开腹。11 例（23.4%）患者发生并发症，平均住院时间为 10.6 天。手术史对围手术期结果无显著影响，但有 HPB 手术史的患者手术时间较长，术后并发症发生率较高。
既往上腹部手术患者行腹腔镜肝切除术是可行和安全的。
