Heinrich Stefan, Lang Hauke
Klinik f. Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland.
Chirurg. 2021 Apr;92(4):316-325. doi: 10.1007/s00104-020-01338-w. Epub 2021 Jan 15.
The evidence for minimally invasive surgery (MIS) of the liver has significantly increased with the increasing number of publications on this topic in recent years; however, this technique has not yet gained broad acceptance among surgeons.
Analysis and presentation of the current literature on MIS of the liver.
Structured PubMed literature search and analysis.
According to the literature, MIS and open liver surgery are equivalent regarding the oncological quality. In addition to parenchyma-preserving resections, major hepatectomies (e.g. hemihepatectomy and sectorectomy), two-stage concepts and re-resections have increasingly been reported. The MIS of the liver is associated with less blood loss and other immunological advantages in addition to a shorter hospital stay. The highest level of evidence has been achieved for colorectal liver metastases for which a systematic review even revealed a survival benefit for patients undergoing MIS surgery. From an oncological perspective, laparoscopic and robotic liver surgery are considered to be equivalent.
According to the current literature MIS of the liver is recommended for the resection of colorectal liver metastases and hepatocellular carcinoma.
近年来，随着关于肝脏微创手术（MIS）的文献数量不断增加，支持该技术的证据显著增多；然而，这项技术尚未在外科医生中得到广泛认可。
分析并展示当前关于肝脏微创手术的文献。
对PubMed文献进行结构化检索与分析。
根据文献，在肿瘤学质量方面，微创手术与开放性肝脏手术相当。除了保留实质的切除术外，大型肝切除术（如半肝切除术和肝段切除术）、两阶段概念以及再次切除术的报道也越来越多。肝脏微创手术除了住院时间较短外，还具有失血较少和其他免疫学优势。对于结直肠癌肝转移，已获得最高级别的证据，一项系统评价甚至显示接受微创手术的患者有生存获益。从肿瘤学角度来看，腹腔镜肝脏手术和机器人辅助肝脏手术被认为是等效的。
根据当前文献，对于结直肠癌肝转移和肝细胞癌的切除，推荐采用肝脏微创手术。
