Machado Marcel Autran Cesar, Makdissi Fábio Ferrari, Surjan Rodrigo Cañada Trofo
Syrian-Lebanese Hospital, São Paulo, Brazil.
Rev Col Bras Cir. 2012 Dec;39(6):483-8. doi: 10.1590/s0100-69912012000600007.
To analyze our experience after 107 laparoscopic hepatectomies and discuss the technical evolution of laparoscopic hepatectomy in the last five years.
Between April 2007 and April 2012 we performed 107 laparoscopic hepatectomies in 105 patients. The mean age was 53.9 years (17 to 85). Fifty-three patients were male. All interventions were performed by the authors.
from the total of 107 operations, there was need for conversion to open technique in three cases (2.8%). Sixteen patients (14.9%) had complications. Two patients died, a mortality of 1.87%. One death was due to massive myocardial infarction, unrelated to the procedure, which was uneventful and showed no conversion or bleeding. The other death was due to failure of the stapler. Twenty patients (18.7%) required blood transfusion. The most frequent type of hepatectomy was bisegmentectomy of segments 2-3, (33 cases), followed by right hepatectomy (22 cases). Seventy-two procedures (67.3%) were performed by the technique of Glissonian access.
The dissemination of results is of utmost importance. The technical difficulties, complications and even death, inherent in this complex type of surgery, need to be clearly disclosed. This procedure should be performed in a specialized center with knowledgeable staff. The technique of laparoscopic Glissonian access, described by our staff, facilitates the realization of anatomical hepatectomies.
分析我们开展107例腹腔镜肝切除术后的经验，并探讨过去五年中腹腔镜肝切除术的技术演变。
2007年4月至2012年4月期间，我们对105例患者实施了107例腹腔镜肝切除术。患者平均年龄53.9岁（17至85岁）。男性患者53例。所有手术均由作者完成。
在总共107例手术中，有3例（2.8%）需要转为开腹手术。16例患者（14.9%）出现并发症。2例患者死亡，死亡率为1.87%。1例死亡是由于大面积心肌梗死，与手术无关，手术过程顺利，未出现中转或出血情况。另1例死亡是由于吻合器故障。20例患者（18.7%）需要输血。最常见的肝切除类型是2-3段双段切除术（33例），其次是右肝切除术（22例）。72例手术（67.3%）采用Glissonian入路技术完成。
结果的传播至关重要。这种复杂手术固有的技术难题、并发症甚至死亡情况都需要明确披露。该手术应在配备专业人员的专业中心进行。我们团队所描述的腹腔镜Glissonian入路技术有助于实施解剖性肝切除术。
