Inoue Yoshihiro, Ishii Masatsugu, Tsuchimoto Yusuke, Masubuchi Shinsuke, Yamamoto Masashi, Asai Akira, Fukunishi Shinya, Hirokawa Fumitoshi, Higuchi Kazuhide, Uchiyama Kazuhisa
Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan.
The Second Department of Internal Medicine, Osaka Medical College Hospital, Osaka, Japan.
Wideochir Inne Tech Maloinwazyjne. 2018 Sep;13(3):333-341. doi: 10.5114/wiitm.2018.75866. Epub 2018 May 21.
The degree of difficulty in laparoscopic hepatic resection (LHR) was higher in tumors involving the suprahepatic segments than other sites. However, thanks to surgical instruments and procedures being improved and standardized, LHR can be performed safely in all regions.
We report our standardized surgical techniques and outcomes in a series of patients undergoing LHR in our hospital and analyze the surgical outcomes, particularly with regard to the site of resection.
We retrospectively analyzed data from 238 patients who underwent standardized laparoscopic partial hepatic resection between 2010 and 2017. In standardized LHR, the operator formed a triangle with the laparoscope in the center, maintaining a co-axial position by changing the port where the laparoscope was inserted.
Operative time for the resection of tumors of the right hepatic lobe was 202 ±92 min and 140 ±104 min for tumors of the left hepatic lobe (p = 0.0024); intraoperative blood loss was 80 ±170 ml and 19 ±127 ml, respectively (p = 0.0016). No differences were found in the surgical outcomes between the various segments of the right hepatic lobe. In the left hepatic lobe, operative time was significantly shorter with laparoscopic tumor resection in segment III (p = 0.0023).
During standardized LHR, a better field of vision with the greater ease can be established during resection of the left hepatic lobe compared to that of the right hepatic lobe. Nonetheless, LHR of the right lobe can be performed safely using various surgical instruments and techniques.
腹腔镜肝切除术（LHR）中，涉及肝上段的肿瘤比其他部位的肿瘤手术难度更高。然而，由于手术器械和操作方法不断改进并标准化，LHR在所有区域均可安全实施。
我们报告我院一系列接受LHR患者的标准化手术技术及结果，并分析手术效果，尤其是与切除部位相关的效果。
我们回顾性分析了2010年至2017年间238例行标准化腹腔镜肝部分切除术患者的数据。在标准化LHR中，术者以腹腔镜为中心形成一个三角形，通过改变腹腔镜插入端口来保持同轴位置。
右肝叶肿瘤切除的手术时间为202±92分钟，左肝叶肿瘤切除的手术时间为140±104分钟（p = 0.0024）；术中出血量分别为80±170毫升和19±127毫升（p = 0.0016）。右肝叶各段之间的手术效果无差异。在左肝叶，Ⅲ段腹腔镜肿瘤切除的手术时间明显更短（p = 0.0023）。
在标准化LHR中，与右肝叶切除相比，左肝叶切除时能更轻松地获得更好的视野。尽管如此，使用各种手术器械和技术，右肝叶的LHR也可安全进行。
