Hasegawa Yasushi, Koffron Alan J, Buell Joseph F, Wakabayashi Go
Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
J Hepatobiliary Pancreat Sci. 2015 May;22(5):335-41. doi: 10.1002/jhbp.214. Epub 2015 Jan 22.
Laparoscopic liver resection has been established as a safe and feasible treatment option. Surgical approaches include pure laparoscopy, hand-assisted laparoscopy (HALS), and the hybrid technique. The role of these three approaches, and their superiority over open laparotomy, is not yet known. A literature review was performed using specific search phrases, relating to hand-assisted or hybrid approaches to laparoscopic liver resection. Surgical results from 18 case series (HALS, nine series; hybrid technique, nine series), each with ≥ 10 patients, were analyzed. Results indicated that HALS was associated with a mean operative time of 82-264.5 min, an estimated blood loss of 82-300 mL, and a complication rate of 3.8-27.1%. Analysis of series involving the hybrid technique indicated a mean operative time of 111-366.5 min, an estimated blood loss of 93-936 mL, and a complication rate of 3.4-23.5%. In conclusion, there is insufficient evidence to conclude that any single approach is superior to the others, although HALS and the hybrid technique are useful when dealing with difficulties associated with pure laparoscopy. Conversely, the need for these two methods, which can function as a bridge to pure laparoscopic liver resection, may be overcome with appropriate training.
腹腔镜肝切除术已被确立为一种安全可行的治疗选择。手术方法包括单纯腹腔镜手术、手辅助腹腔镜手术（HALS）和杂交技术。这三种方法的作用及其相对于开放剖腹手术的优势尚不清楚。使用与腹腔镜肝切除手术的手辅助或杂交方法相关的特定搜索短语进行了文献综述。分析了18个病例系列（HALS，9个系列；杂交技术，9个系列）的手术结果，每个系列至少有10例患者。结果表明，HALS的平均手术时间为82 - 264.5分钟，估计失血量为82 - 300毫升，并发症发生率为3.8 - 27.1%。对涉及杂交技术的系列分析表明，平均手术时间为111 - 366.5分钟，估计失血量为93 - 936毫升，并发症发生率为3.4 - 23.5%。总之，虽然HALS和杂交技术在处理与单纯腹腔镜手术相关的困难时很有用，但没有足够的证据得出任何一种方法优于其他方法的结论。相反，通过适当的培训，可能可以克服对这两种可作为通向单纯腹腔镜肝切除桥梁的方法的需求。
