Ghimire Roshan, Mishra Aakash, Limbu Yugal, Regmee Sujan, Maharjan Dhiresh Kumar, Thapa Prabin Bikram
Department of Gastrointestinal and General Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
Ann Med Surg (Lond). 2023 Apr 17;85(5):1566-1570. doi: 10.1097/MS9.0000000000000702. eCollection 2023 May.
Laparoscopic liver resection is taking stride in slowly replacing open surgeries for various hepatic pathologies in many developed countries. However, due to high cost and lack of expertise, there are only a handful of centres in the low-medium income countries who perform advanced laparoscopic liver resections regularly. In this study, a prospective analysis was carried out to assess and report the outcomes of laparoscopic anatomical segmentectomy (LAS) from a single centre in Nepal.
The clinical data of all patients who underwent LAS between 1 October 2021 to 30 September 2022 were prospectively recorded. Demographics, pathological diagnoses, types of resections performed, perioperative parameters, postoperative length of stay, postoperative complications data and IWATE score were collected and analyzed. All operations were performed using the extrahepatic Glissonean technique with the use of indocyanine green dye as an adjunct during the intraoperative period.
In the study period, a total of 16 LAS were performed in our centre for various indications. The mean age of the patients in the series was 41.6 years, and seven of 16 patients were male. The majority of the cases were segment 2/3 resection indicated for various pathologies and segment 4b/5 indicated for carcinoma gallbladder. The median hospital stay was 6 days and only two cases developed major complication. There were no mortalities in our series.
Taking into account the results produced from a single centre in a low-medium income country, laparoscopic anatomical segmentectomy is technically feasible with an acceptable safety profile.
在许多发达国家，腹腔镜肝切除术正逐渐取代开腹手术用于治疗各种肝脏疾病。然而，由于成本高昂且缺乏专业技术，中低收入国家只有少数几个中心定期开展先进的腹腔镜肝切除术。在本研究中，我们进行了一项前瞻性分析，以评估并报告尼泊尔一个单一中心的腹腔镜解剖性肝段切除术（LAS）的结果。
前瞻性记录了2021年10月1日至2022年9月30日期间所有接受LAS的患者的临床数据。收集并分析了人口统计学资料、病理诊断、所施行的切除类型、围手术期参数、术后住院时间、术后并发症数据及岩手评分。所有手术均采用肝外Glissonean技术，并在术中使用吲哚菁绿染料作为辅助。
在研究期间，我们中心共进行了16例LAS，用于各种适应证。该系列患者的平均年龄为41.6岁，16例患者中有7例为男性。大多数病例为因各种病变而行的2/3段切除以及因胆囊癌而行的4b/5段切除。中位住院时间为6天，仅有2例发生严重并发症。我们的系列中无死亡病例。
考虑到中低收入国家一个单一中心得出的结果，腹腔镜解剖性肝段切除术在技术上是可行的，且安全性可接受。
