Hirokawa Fumitoshi, Hayashi Michihiro, Asakuma Mitsuhiro, Shimizu Tetsunosuke, Inoue Yoshihiro, Uchiyama Kazuhisa
Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
World J Surg. 2017 May;41(5):1340-1346. doi: 10.1007/s00268-016-3867-5.
Laparoscopic resection of posterosuperior (PS) tumors of the liver is more difficult than that of anterolateral (AL) tumors, owing to the narrow surgical field in the PS location. In this retrospective cohort study, our aim was to determine if port insertion through the intercostal space would lead to improved outcomes for laparoscopic resection of tumors in PS liver segments 7 and 8.
Between January 2006 and December 2015, 153 patients underwent laparoscopic resection of solitary liver tumors at Osaka Medical College Hospital. Of these, 107 patients had AL lesions, and 46 had PS lesions. Of the 46 patients with a PS lesion, 23 underwent an abdominal-only approach, and 23 underwent the intercostal trocar approach. Multivariate analyses were performed to investigate outcomes.
Conventional abdominal-only laparoscopic resection of PS liver tumors resulted in prolonged surgical time (P = 0.031), increased bleeding (P = 0.012), and a higher open conversion rate (P = 0.022) compared with AL tumors. Among patients with PS tumors, the open conversion rate was significantly higher for those treated with the abdominal-only approach than with the intercostal trocar approach (P = 0.047). Appropriate surgical margins were obtained equally using the intercostal trocar approach (P = 0.648). There was no significant difference in occurrence of complications between the abdominal-only group and the intercostal trocar group.
Using the intercostal trocar approach for PS liver lesions is a safe and effective method, which significantly reduced the open conversion rate compared with the conventional abdominal-only approach.
由于后上（PS）段肝脏肿瘤手术视野狭窄，腹腔镜下切除肝脏后上（PS）段肿瘤比前外侧（AL）段肿瘤更具难度。在这项回顾性队列研究中，我们旨在确定经肋间隙插入端口是否能改善腹腔镜下切除肝脏PS段7和8肿瘤的手术效果。
2006年1月至2015年12月期间，153例患者在大阪医科大学附属医院接受了腹腔镜下孤立性肝肿瘤切除术。其中，107例患者为AL段病变，46例为PS段病变。在46例PS段病变患者中，23例采用单纯经腹入路，23例采用肋间套管针入路。进行多因素分析以研究手术效果。
与AL段肿瘤相比，传统的单纯经腹腹腔镜切除PS段肝脏肿瘤导致手术时间延长（P = 0.031）、出血量增加（P = 0.012）和开腹转换率更高（P = 0.022）。在PS段肿瘤患者中，单纯经腹入路治疗的患者开腹转换率显著高于肋间套管针入路治疗的患者（P = 0.047）。使用肋间套管针入路同样能获得合适的手术切缘（P = 0.648）。单纯经腹组和肋间套管针组之间并发症的发生率没有显著差异。
对PS段肝脏病变采用肋间套管针入路是一种安全有效的方法，与传统的单纯经腹入路相比，显著降低了开腹转换率。
