Hsu Kuo-Feng, Liu Tsang-Pai, Yu Jyh-Cherng, Chen Teng-Wei, Shih Ming-Lang, Ou Kuang-Ling, Chen Cheng-Jueng, Chan De-Chuan, Hsieh Chung-Bao
Department of Surgery, National Defense Medical Center, Division of General Surgery, Tri-Service General Hospital, Taipei, Taiwan.
Surg Laparosc Endosc Percutan Tech. 2012 Aug;22(4):e186-9. doi: 10.1097/SLE.0b013e318256b6e4.
Laparoscopic liver resection has become a feasible and safe procedure for liver tumor, but it requires experienced surgeons in the case of hepatobiliary and laparoscopic surgeries. More minimally invasive laparoscopic techniques of liver surgery are developed. We here report our experience of using a marionette technique for 3-port laparoscopic liver resection.
Between June 2009 and December 2010, 7 patients underwent 3-port laparoscopic liver resection with the use of marionette technique. Five patients had hepatocellular carcinoma. Two patients with prior abdominal operations for colon cancer had colorectal liver metastasis. The procedure of marionette technique was performed as below: after insertion of the 3 trocars, a 2-0 nylon straight needle line was inserted through the abdominal wall, and using the needle holder, it was allowed to traverse the liver edge twice. Then, the straight needle line was forced out of the abdominal wall and clamped using mosquito for traction. Another straight needle line was similarly created at the opposite side of the liver edge.
None of the patients had to be converted to open surgery. The mean operative time was 96.7 ± 63.2 minutes (range, 45 to 195 min), and the mean volume of blood loss was 45.6 ± 27.9 mL (range, 30 to 100 mL). The mean pain score recorded on the visual analog scale was 2.7 ± 0.8. The mean hospital stay was 5.6 ± 1.7 days (range, 4 to 9 d). Currently, all the 7 patients are alive, and the tumors have not recurred (Supplementary Digital Content video 1 http://links.lww.com/SLE/A67).
Our experience demonstrated that the simple marionette technique procedure could help surgeons ease laparoscopic liver resection and achieve better postoperative results.
腹腔镜肝切除术已成为一种治疗肝脏肿瘤可行且安全的手术方式，但对于肝胆及腹腔镜手术而言，这需要经验丰富的外科医生。更多微创的腹腔镜肝脏手术技术得以发展。在此，我们报告使用牵线木偶技术进行三孔腹腔镜肝切除术的经验。
2009年6月至2010年12月期间，7例患者接受了使用牵线木偶技术的三孔腹腔镜肝切除术。5例患者患有肝细胞癌。2例曾因结肠癌接受腹部手术的患者出现了结直肠癌肝转移。牵线木偶技术的操作步骤如下：插入3个套管针后，将一根2-0尼龙直针线经腹壁插入，使用持针器使其两次穿过肝边缘。然后，将直针线从腹壁穿出，用蚊式钳夹住用于牵引。在肝边缘的对侧以同样的方式制作另一根直针线。
所有患者均无需转为开腹手术。平均手术时间为96.7±63.2分钟（范围45至195分钟），平均失血量为45.6±27.9毫升（范围30至100毫升）。视觉模拟量表记录的平均疼痛评分为2.7±0.8。平均住院时间为5.6±1.7天（范围4至9天）。目前，所有7例患者均存活，肿瘤未复发（补充数字内容视频1 http://links.lww.com/SLE/A67）。
我们的经验表明，简单的牵线木偶技术操作可帮助外科医生简化腹腔镜肝切除术并取得更好的术后效果。
