Kang Sung-Hwa, Kim Ki-Hun, Shin Min-Ho, Yoon Young-In, Kim Wan-Jun, Jung Dong-Hwan, Park Gil-Chun, Ha Tae-Yong, Lee Sung-Gyu
Department of Surgery, Dong-A University Medical Center, Dong-A University College of Medicine, Busan Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Medicine (Baltimore). 2016 Oct;95(43):e5182. doi: 10.1097/MD.0000000000005182.
The aim of the study was to report surgical outcomes (efficacy and safety) of laparoscopic major hepatectomy for various liver diseases.Although the number of laparoscopic liver resections has increased, expansion of laparoscopic major hepatic resection remains limited, mainly owing to the technical difficulties for the procedure as compared to open surgery. We describe our experiences with laparoscopic major hepatectomy for various liver diseases.We retrospectively reviewed the medical records of 192 patients who underwent laparoscopic major hepatectomy between October 2007 and March 2015 at Asan Medical Center, Korea.The mean age of the patients was 54 ± 11.6 years, and their mean body mass index was 23.5 kg/m. The most common preoperative diagnosis was hepatocellular carcinoma (n = 82, 42.7%), followed by intrahepatic duct stones (n = 51, 26.6%). We performed 108 left hepatectomies, 55 right hepatectomies, 18 right posterior sectionectomies, 6 right anterior sectionectomies, 2 central bisectionectomies, and 3 donor right hepatectomies. The conversion rate was 1.6% (3 cases) due to bleeding, bile leakage, and uncontrolled hypercapnea during the operation. The mean operation time was 272 ± 80.2 minutes, and the mean estimated blood loss was 300.4 ± 252.2 mL. The mean postoperative hospital stay was 9.8 days. All resection margins were tumor-free in cases of malignant tumors. The morbidity rate was 3.1% (n = 6), including for case of biliary stricture. There were no deaths.Laparoscopic major hepatectomy, including donor hepatectomy, is a safe and feasible option for various liver diseases when careful selection criteria are used by a surgeon experienced with the relevant surgical techniques.
本研究的目的是报告腹腔镜下大型肝切除术治疗各种肝脏疾病的手术效果（疗效和安全性）。尽管腹腔镜肝切除术的数量有所增加，但腹腔镜下大型肝切除术的推广仍然有限，主要是因为与开放手术相比，该手术存在技术困难。我们描述了我们在腹腔镜下大型肝切除术治疗各种肝脏疾病方面的经验。我们回顾性分析了2007年10月至2015年3月在韩国峨山医疗中心接受腹腔镜下大型肝切除术的192例患者的病历。患者的平均年龄为54±11.6岁，平均体重指数为23.5kg/m。最常见的术前诊断是肝细胞癌（n = 82，42.7%），其次是肝内胆管结石（n = 51，26.6%）。我们进行了108例左肝切除术、55例右肝切除术、18例右后叶切除术、6例右前叶切除术、2例中央二分叶切除术和3例供体右肝切除术。由于手术中出血、胆漏和无法控制的高碳酸血症，中转开腹率为1.6%（3例）。平均手术时间为272±80.2分钟，平均估计失血量为300.4±252.2毫升。术后平均住院时间为9.8天。恶性肿瘤病例的所有切缘均无肿瘤残留。并发症发生率为3.1%（n = 6），包括胆管狭窄病例。无死亡病例。当经验丰富的外科医生使用仔细的选择标准时，包括供体肝切除术在内的腹腔镜下大型肝切除术是治疗各种肝脏疾病的一种安全可行的选择。
