Jung Ryong Ho, Kim Hyug Won, Yoon Sam-Youl
Department of Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Department of Surgery, Hallym Sacred Heart Hospital, Anyang, Korea.
Korean J Clin Oncol. 2021 Dec;17(2):122-125. doi: 10.14216/kjco.21019. Epub 2021 Dec 31.
Laparoscopic hepatectomy has been widely performed by hepatobiliary surgeons for malignancy of liver and gained wide acceptance for various liver tumors, thanks to advances in surgical techniques and devices. But, there are some challenges for right side tumor in patients of cirrhotic liver. Especially, tumor located in right upper area is difficult for wedge resection in patients with marginal liver function, because trans-abdominal approach requires normal parenchymal dissection. Radiofrequency wave ablation is also difficult for such a lesion. So, we demonstrate unique technique of video-assisted transthoracic liver resection (VTLR) for overcome right upper side tumor abutting diaphragm.
Four patients underwent VTLR. Four ports in right chest wall were created by a chest surgeon and diaphragm was open. Then traction of the diaphragm was done by suture. After exposure of liver surface, tumor localization was done by ultrasound. The mass excision was done by ultrasonic shear.
Four patients were discharged without complications within 11.3 days (range, 6-15 days). On average, patients started to consume a normal diet on an average of 2.4 days (range, 1-4 days).
VTLR is could be performed by an experienced surgeon and chest surgeon for right upper liver malignancy abutting diaphragm in patient of marginal liver function.
由于手术技术和设备的进步，腹腔镜肝切除术已被肝胆外科医生广泛用于治疗肝脏恶性肿瘤，并在各种肝脏肿瘤中得到广泛认可。但是，对于肝硬化肝脏患者的右侧肿瘤，存在一些挑战。特别是，位于右上区域的肿瘤对于肝功能边缘的患者进行楔形切除很困难，因为经腹入路需要正常的实质解剖。对于这样的病变，射频消融也很困难。因此，我们展示了一种独特的视频辅助经胸肝切除术（VTLR）技术，以克服紧邻膈肌的右上侧肿瘤。
4例患者接受了VTLR。胸外科医生在右胸壁创建4个切口并打开膈肌。然后通过缝合进行膈肌牵引。暴露肝脏表面后，通过超声进行肿瘤定位。通过超声剪进行肿块切除。
4例患者在11.3天内（范围6 - 15天）无并发症出院。平均而言，患者平均在2.4天（范围1 - 4天）开始正常饮食。
经验丰富的外科医生和胸外科医生可以对肝功能边缘且紧邻膈肌的右上肝恶性肿瘤患者进行VTLR。
