Piros László, Máthé Zoltán
Transzplantációs és Sebészeti Klinika, Semmelweis Egyetem, Budapest, Hungary.
Magy Onkol. 2018 Mar 23;62(1):37-44. Epub 2018 Jan 31.
More than 9000 laparoscopic liver resections (LLR) are performed worldwide for benign lesions, malignancy (mainly for hepatocellular carcinoma and colorectal cancer liver metastasis), and living donor hepatectomy. Although there is no absolute size criterion, smaller, peripheral lesions (<5 cm) of the anteriolateral segments, that lie far from major vessels and anticipated transection planes are most amenable to LLR, but nowadays lesions of the less ideal posterosuperior segments are feasible for LLR too. Centers with extensive experience in hepatobiliary surgery and laparoscopy have performed laparoscopic major hepatic resections with satisfactory outcomes. Patient benefits from LLR include less intraoperative blood loss, less postoperative pain and painkiller requirement, early mobilization and shorter length of hospital stay, with comparable postoperative morbidity and mortality to open liver resection. Comparison studies between open resection and LLR have revealed no differences in width of resection margins or overall survival after resection for hepatocellular cancer or colorectal cancer liver metastases. Other advantages of LLR for HCC are avoidance of collateral vessel ligation, decreased postoperative hepatic insufficiency and fewer postoperative adhesions, all of them facilitates a possible subsequent liver transplantation.
全球范围内，超过9000例腹腔镜肝切除术（LLR）用于治疗良性病变、恶性肿瘤（主要是肝细胞癌和结直肠癌肝转移）以及活体供肝肝切除术。尽管没有绝对的大小标准，但位于前外侧段、远离主要血管和预期横断平面的较小（<5 cm）周边病变最适合进行LLR，不过如今位于不太理想的后上段的病变也可行LLR。在肝胆外科和腹腔镜手术方面经验丰富的中心已开展了腹腔镜大肝切除术，效果令人满意。LLR给患者带来的益处包括术中失血更少、术后疼痛减轻及止痛药需求减少、早期活动和住院时间缩短，术后发病率和死亡率与开腹肝切除术相当。开腹切除术与LLR之间的比较研究表明，肝细胞癌或结直肠癌肝转移切除术后的切缘宽度或总体生存率并无差异。LLR对肝癌的其他优势包括避免结扎侧支血管、减少术后肝功能不全以及减少术后粘连，所有这些都有助于后续可能的肝移植。
