Francone Elisa, Muzio Elena, D'Ambra Luigi, Aschele Carlo, Stefanini Teseo, Sani Cinzia, Falco Emilio, Berti Stefano
General Surgery Unit, Department of Surgery, S. Andrea Hospital, POLL-ASL5, Via Vittorio Veneto 197, 19100, La Spezia, Italy.
Medical Oncology Unit, S. Andrea Hospital, POLL-ASL5, La Spezia, Italy.
Surg Endosc. 2017 Mar;31(3):1354-1360. doi: 10.1007/s00464-016-5120-6. Epub 2016 Jul 21.
For the treatment of both primary and metastatic liver tumors, laparoscopic parenchyma-sparing surgery is advocated to reduce postoperative liver failure and facilitate reoperation in the case of recurrence. However, atypical and wedge resections are associated with a higher amount of intraoperative bleeding than are anatomical resections, and such bleeding is known to affect short- and long-term outcomes. Beyond the established role of radiofrequency and microwave ablation in the setting of inoperable liver tumors, the application of thermoablative energy along the plane of the liver surface to be transected results in a zone of coagulative necrosis, possibly minimizing bleeding of the cut liver surface during parenchymal transection.
From January 2013 to March 2016, a total of 20 selected patients underwent laparoscopic ultrasound-guided liver resection with thermoablative precoagulation of the transection line.
During a period of 38 months, 50 laparoscopic thermoablative procedures were performed. Colorectal liver metastases were the most frequent diagnosis. Seventy-two percent of the nodules were removed using parenchymal transection with radiofrequency-precoagulation, while microwave-precoagulation was performed for 20 % of the resected nodules. The remaining 8 % of the nodules were treated by thermoablation alone. The hepatic pedicle was intermittently clamped in six patients. The mean blood loss was 290 mL, and four patients required perioperative transfusions.
Precoagulation-assisted parenchyma-sparing laparoscopic liver surgery can get minimal blood loss during parenchymal transection and lower the need for perioperative transfusions, providing a nonquantifiable margin of oncological safety on the remaining liver. Additional results from larger series are advocated to confirm these preliminary data.
对于原发性和转移性肝肿瘤的治疗，提倡采用保留实质的腹腔镜手术，以减少术后肝衰竭的发生，并便于在复发时再次手术。然而，非典型和楔形切除术的术中出血量比解剖性切除术更多，且已知这种出血会影响短期和长期预后。除了射频和微波消融在不可切除肝肿瘤治疗中已确立的作用外，在拟横断的肝表面平面应用热消融能量会导致凝固性坏死区域，这可能会使实质横断期间肝切面的出血降至最低。
2013年1月至2016年3月，共有20例选定患者接受了腹腔镜超声引导下的肝切除术，并对横断线进行热消融预凝。
在38个月的时间里，共进行了50例腹腔镜热消融手术。最常见的诊断为结直肠癌肝转移。72%的结节通过射频预凝的实质横断术切除，20%的切除结节采用微波预凝。其余8%的结节仅接受热消融治疗。6例患者间歇性阻断肝蒂。平均失血量为290毫升，4例患者需要围手术期输血。
预凝辅助保留实质的腹腔镜肝手术在实质横断期间可使失血量降至最低，并降低围手术期输血需求，为剩余肝脏提供不可量化的肿瘤学安全 margin。提倡更大系列研究的更多结果来证实这些初步数据。
