Kupcsulik Péter
Semmelweis Egyetem I. Sz. Sebészeti Klinika 1082 Budapest Üllői út 78.
Magy Seb. 2014 Aug;67(4):243-51. doi: 10.1556/MaSeb.67.2014.4.1.
Liver resection remains the method of choice for curative treatment for liver tumors. Development in diagnostic and surgical techniques has improved operative results as well as long-term outcomes. In the last decade minimally invasive laparoscopic (LAP) surgery has been increasingly adopted by liver units. The trend in LAP liver resection has been moving from limited resections towards major hepatectomy. This process, however, is relatively slow, which can be due to technical difficulties of the procedure and fear of haemorrhage. Despite having a hard time at the start, major resections become more common. Up to now approximately 6000 LAP liver resections were performed worldwide, number of major hepatectomies is estimated between 700-800. LAP liver resections are feasible with significant benefits for patients consisting of less blood loss, less narcotic requirements, and shorter hospital stay with comparable postoperative morbidity and mortality to open liver resections. It is an accepted management of both benign and malignant liver lesions. There is no difference between LAP and open surgery in late survival after resection for colorectal liver metastases. Overall survival of LAP resected hepatocellular carcinoma cases seems to be superior compared with open surgery.
肝切除术仍然是肝肿瘤根治性治疗的首选方法。诊断和手术技术的发展改善了手术效果以及长期预后。在过去十年中,微创腹腔镜(LAP)手术越来越多地被肝脏外科采用。LAP肝切除术的趋势已从有限切除转向扩大肝切除术。然而,这一过程相对缓慢,这可能是由于该手术的技术难度以及对出血的恐惧。尽管一开始困难重重,但扩大切除术变得越来越普遍。到目前为止,全球范围内大约进行了6000例LAP肝切除术,扩大肝切除术的数量估计在700 - 800例之间。LAP肝切除术是可行的,对患者有显著益处,包括失血更少、麻醉需求更少、住院时间更短,术后发病率和死亡率与开腹肝切除术相当。它是良性和恶性肝脏病变的一种公认治疗方法。对于结直肠癌肝转移切除术后的晚期生存,LAP手术和开腹手术没有差异。LAP切除的肝细胞癌病例的总体生存率似乎优于开腹手术。