Endo Tomoyoshi, Morise Zenichi, Katsuno Hidetoshi, Kikuchi Kenji, Matsuo Kazuhiro, Asano Yukio, Horiguchi Akihiko
Department of Surgery, Fujita Health University School of Medicine Okazaki Medical Center, Okazaki, Japan.
Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya, Japan.
Front Oncol. 2022 Jul 11;12:950283. doi: 10.3389/fonc.2022.950283. eCollection 2022.
We had reported the novel concept of "caudal approach in laparoscopic liver resection" in 2013. In the first report, the caudal approach of laparoscopic transection-first posterior sectionectomy without prior mobilization of the liver in the left lateral position was described. Thereafter, 10 complex laparoscopic extended posterior sectionectomies with combined resection of the right hepatic vein or diaphragm were performed using the same approach. In the present study, the short-term outcomes of these cases and 42 cases of laparoscopic sectionectomies or hemi-hepatectomies (excluding left lateral sectionectomy) were compared. There was no statistically significant difference between the groups in terms of patients' backgrounds, diseases for resection, preoperative liver function, tumor number and size, as well as outcomes, operation time, intraoperative blood loss, morbidity, conversion to laparotomy, and post-operative hospital stay. Even complex laparoscopic extended posterior sectionectomy was safely performed using this procedure. This approach has the technical benefits of acquiring a well-opened transection plane between the resected liver fixed to the retroperitoneum and the residual liver sinking to the left with the force of gravity during parenchymal transection, and less bleeding from the right hepatic vein due to its higher position than the inferior vena cava. Furthermore, it has an oncological benefit similar to that of the anterior approach in open liver resection, even in posterior sectionectomy. The detailed procedure and general conceptual benefits of the caudal approach to laparoscopic liver resection for repeated multimodal treatment for hepatocellular carcinoma are described.
2013年，我们报道了“腹腔镜肝切除术中的尾侧入路”这一全新概念。在首篇报道中，描述了在左侧卧位下，不经预先游离肝脏，先行腹腔镜下离断式第一肝段切除术的尾侧入路。此后，采用相同入路进行了10例复杂的腹腔镜扩大右后叶切除术，同时联合切除右肝静脉或膈肌。在本研究中，比较了这些病例与42例腹腔镜肝段切除术或半肝切除术（不包括左外叶肝段切除术）的短期疗效。两组在患者背景、切除疾病、术前肝功能、肿瘤数量和大小以及疗效、手术时间、术中出血量、发病率、中转开腹和术后住院时间方面均无统计学显著差异。即使是复杂的腹腔镜扩大右后叶切除术，采用该手术方式也能安全实施。这种入路在实质离断过程中具有技术优势，即能在固定于后腹膜的切除肝脏与因重力作用向左下沉的残余肝脏之间获得良好的离断平面，且由于右肝静脉位置高于下腔静脉，其出血较少。此外，即使在右后叶切除术中，该入路在肿瘤学方面的获益与开放肝切除术中的前入路相似。本文描述了用于肝细胞癌重复多模式治疗的腹腔镜肝切除术中尾侧入路的详细手术步骤及一般概念上的优势。
