Inoue Yoshihiro, Hayashi Michihiro, Tanaka Ryo, Komeda Koji, Hirokawa Fumitoshi, Uchiyama Kazuhisa
Departments of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan.
Am Surg. 2013 May;79(5):495-501.
Laparoscopic liver resection is currently performed in an increasing number of institutions as a minimally invasive treatment. However, no randomized controlled trials have compared laparoscopic and open liver resections. Twenty-three laparoscopic and 24 open liver resections for colorectal cancer liver metastases (CRCLM) were performed, and these data for both were retrospectively compared in the short-term results. The estimated blood loss was 99 ± 207 mL in the laparoscopic group and 397 ± 381 mL in the open group (P = 0.0018); blood loss was significantly higher in the open group. There were no differences in the surgical procedure, blood loss, transfusion rate, pathological margins, postoperative complications, 30-day mortality, duration of intravenous drip, or hospital stay. On postoperative courses, the values of total bilirubin, white blood cell count, and C-reactive protein were significantly lower in the laparoscopic group. The data of the present series suggest the lesser invasiveness and safety of laparoscopic liver resection even for patients with CRCLM, and they showed that postoperative laboratory tests were better after laparoscopy than after the traditional open approach with better short-term results. Tumor diameter less than 5 cm appears to be the appropriate indication for laparoscopic liver resection for CRCLM.
作为一种微创治疗方法，腹腔镜肝切除术目前在越来越多的机构中开展。然而，尚无随机对照试验对腹腔镜肝切除术和开放性肝切除术进行比较。我们对23例因结直肠癌肝转移（CRCLM）行腹腔镜肝切除术和24例因CRCLM行开放性肝切除术的患者进行了研究，并对二者的短期结果进行了回顾性比较。腹腔镜组的估计失血量为99±207 mL，开放组为397±381 mL（P = 0.0018）；开放组的失血量显著更高。两组在手术方式、失血量、输血率、病理切缘、术后并发症、30天死亡率、静脉滴注时间或住院时间方面均无差异。在术后病程中，腹腔镜组的总胆红素、白细胞计数和C反应蛋白值显著更低。本系列数据表明，即使对于CRCLM患者，腹腔镜肝切除术的侵袭性更小且更安全，并且显示腹腔镜术后的实验室检查结果优于传统开放手术，短期结果更好。肿瘤直径小于5 cm似乎是CRCLM患者行腹腔镜肝切除术的合适指征。
