Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400037, China.
BMC Gastroenterol. 2022 May 8;22(1):224. doi: 10.1186/s12876-022-02289-8.
Pure laparoscopic liver resection (LLR) of segment 8 (S8) is still rarely performed due to the lack of an appropriate surgical approach. This article discusses the technical tips and operation methods for LLR of S8 via a hepatic parenchymal transection-first approach.
Clinical data of 22 patients who underwent LLR of S8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein (MHV) in the Second Affiliated Hospital, Third Military Medical University (Army Medical University) from May 2017 to February 2020 were retrospectively analyzed.
The mean age was 51.1 ± 11.6 years; mean operation time, 186.6 ± 18.4 min; median blood loss, 170.0 ml (143.8-205.0 ml); and median length of hospital stay, 8.0 days (7.0-9.0 days). There was no case of open conversion. Pathologic findings revealed all cases of hepatocellular carcinoma (HCC). Pathology showed free surgical margins. Post-operative complications included liver section effusion, pleural effusion, pneumonia, intra-abdomen bleeding and bile leak. All the complications responded well to conservative treatment. No other abnormality was noted during outpatient follow-up examination. All patients survived tumor-free.
LLR of S8 is still quite challenging at present, and it is our goal to design a reasonable procedure with accurate efficacy and high safety. We use hepatic parenchymal transection-first approach guided by the MHV for LLR of S8. This technique overcomes the problem of high technical risk, greatly reduces the surgical difficulty and achieves technological breakthroughs, but there are still many problems worth further exploration.
由于缺乏合适的手术入路，单纯腹腔镜肝切除术（LLR）切除 8 段（S8）仍然很少进行。本文讨论了在中肝静脉（MHV）引导下通过肝实质切开首先进行 LLR 的技术要点和手术方法。
回顾性分析 2017 年 5 月至 2020 年 2 月第三军医大学第二附属医院采用肝实质切开首先进行 MHV 引导的 LLR 治疗 S8 的 22 例患者的临床资料。
患者平均年龄为 51.1±11.6 岁；平均手术时间为 186.6±18.4 分钟；中位出血量为 170.0ml（143.8-205.0ml）；中位住院时间为 8.0 天（7.0-9.0 天）。无中转开腹病例。病理结果均为肝细胞癌（HCC）。病理显示无切缘残留。术后并发症包括肝断面积液、胸腔积液、肺炎、腹腔内出血和胆漏。所有并发症均经保守治疗后好转。门诊随访检查无其他异常。所有患者均无肿瘤生存。
目前 S8 的 LLR 仍然具有相当的挑战性，我们的目标是设计一种具有准确疗效和高安全性的合理程序。我们使用 MHV 引导的肝实质切开首先进行 S8 的 LLR。该技术克服了技术风险高的问题，大大降低了手术难度，实现了技术突破，但仍有许多问题值得进一步探讨。
