Ogiso Satoshi, Conrad Claudius, Araki Kenichiro, Nomi Takeo, Anil Zeynal, Gayet Brice
*Department of Digestive Pathology, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France †Division of Hepato-Pancreato-Biliary and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan ‡Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Ann Surg. 2015 Aug;262(2):358-65. doi: 10.1097/SLA.0000000000001015.
We describe the technical details and evaluate the safety, feasibility, and usefulness of a combined lateral and abdominal (CLA) approach for laparoscopic resection of liver segments 7 and 8.
Laparoscopic resection of lesions in the posterosuperior area of segments 7 and 8 is technically challenging, and currently there is no standardized laparoscopic approach.
Through review of a prospectively maintained database, we identified 44 patients who underwent laparoscopic resection of lesions in segment 7 or 8. Twenty-five patients required the CLA approach because their lesions were more posterosuperior and intraparenchymal; 19 patients underwent resection with a regular abdominal-only approach of more accessible anteroinferior lesions. We reviewed operative details and video footage of these operations and compared the outcomes of the 2 groups.
In the group treated with the CLA approach, deep location was more frequent (88% vs 42%; P = 0.035), median tumor diameter was larger (24.5 mm vs 15 mm; P = 0.114), and the median weight of the excised parenchyma was greater (56.5 g vs 23 g; P = 0.093). Median operative time was longer in the CLA approach group (217.5 minutes vs 165 minutes; P = 0.046), but blood loss, rate of conversion to open surgery, surgical margin status, morbidity, and mortality were similar between the 2 groups.
The CLA approach permits safe laparoscopic resection of lesions in the posterosuperior area of segments 7 and 8, allowing surgeons to overcome the difficulties of limited visualization and access to the target lesions.
我们描述联合外侧和腹部（CLA）入路用于腹腔镜切除肝段7和8的技术细节，并评估其安全性、可行性和实用性。
腹腔镜切除肝段7和8后上区域的病变在技术上具有挑战性，目前尚无标准化的腹腔镜入路。
通过回顾前瞻性维护的数据库，我们确定了44例行腹腔镜切除肝段7或8病变的患者。25例患者因病变位置更靠后上且位于实质内而需要CLA入路；19例患者采用常规单纯经腹入路切除位置更靠前下、更容易接近的病变。我们回顾了这些手术的操作细节和视频资料，并比较了两组的结果。
在采用CLA入路治疗的组中，病变位置更深的情况更常见（88%对42%；P = 0.035），肿瘤中位直径更大（24.5 mm对15 mm；P = 0.114），切除的肝实质中位重量更重（56.5 g对23 g；P = 0.093）。CLA入路组的中位手术时间更长（217.5分钟对165分钟；P = 0.046），但两组之间的失血量、中转开腹率、手术切缘情况、发病率和死亡率相似。
CLA入路允许安全地腹腔镜切除肝段7和8后上区域的病变，使外科医生能够克服可视化受限和难以接近目标病变的困难。
