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腹腔镜手术是否是肝尾叶良性病变的首选治疗方法?

Is laparoscopic surgery a preferred option for benign conditions in the caudate lobe of the liver?

机构信息

Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650102, Yunnan, China.

出版信息

Langenbecks Arch Surg. 2023 Sep 26;408(1):379. doi: 10.1007/s00423-023-03116-8.

DOI:10.1007/s00423-023-03116-8
PMID:37749360
Abstract

BACKGROUND/AIM: Laparoscopic hepatectomy has become a common management strategy for liver tumors owing to its less invasive nature and enhanced visual perspective. Yet, its use in the caudate lobe poses challenges. This study evaluates the experiences of patients who underwent laparoscopic hepatectomy for hepatic tumors in the caudate lobe and aims to propose strategies for performing such procedures.

METHODS

We retrospectively analyzed the clinical data of twelve patients who underwent laparoscopic hepatic caudate lobe resection at the Department of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Kunming Medical University.

RESULTS

All twelve laparoscopic procedures were successful, with none requiring conversion to open surgery. The surgical methods varied: five cases involved simple resection of the Spiegel lobe, one case involved total caudate lobe resection, three cases involved paravena cava lobe resection, and three cases involved resection of the caudate process. The operation time ranged from 49 to 319 min (mean, 219 min). Intraoperative blood loss ranged from 20 to 500 ml, averaging 194 ml. No patients needed blood transfusions during or after the operation, and there were no instances of postoperative bleeding, bile leakage, or abdominal infection.

CONCLUSION

Given adequate control of hepatic inflow, sufficient exposure to the surgical field, and an appropriate approach, laparoscopic hepatectomy in the caudate lobe could potentially become a standard surgical technique.

摘要

背景/目的:腹腔镜肝切除术因其微创性和增强的视觉效果,已成为肝脏肿瘤的常见治疗策略。然而,在尾状叶使用它存在挑战。本研究评估了在昆明医科大学第二附属医院肝胆胰外科接受腹腔镜肝尾状叶切除术的患者的经验,并旨在提出实施此类手术的策略。

方法

我们回顾性分析了在昆明医科大学第二附属医院肝胆胰外科接受腹腔镜肝尾状叶切除术的 12 例患者的临床资料。

结果

所有 12 例腹腔镜手术均成功,无一例需要转为开放性手术。手术方法各异:5 例涉及 Spiegel 叶单纯切除术,1 例涉及肝尾状叶全切除术,3 例涉及腔静脉旁叶切除术,3 例涉及尾状突切除术。手术时间为 49 至 319 分钟(平均 219 分钟)。术中出血量为 20 至 500 毫升,平均 194 毫升。术中无输血,术后无出血、胆漏或腹腔感染。

结论

如果能够充分控制肝血流、充分暴露手术视野并采用适当的方法,腹腔镜肝切除术在尾状叶可能成为一种标准的手术技术。

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本文引用的文献

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Fluorescence-guided laparoscopic liver resection of caudate lobe for hepatic cystadenoma: A video article.荧光引导下腹腔镜尾状叶肝切除术治疗肝囊腺瘤:视频文章
Asian J Surg. 2023 Jul;46(7):2903-2904. doi: 10.1016/j.asjsur.2023.01.108. Epub 2023 Feb 15.
2
Procedural outcomes of laparoscopic caudate lobe resection: A systematic review and meta-analysis.腹腔镜尾状叶切除术的手术结果:一项系统评价和荟萃分析。
Ann Hepatobiliary Pancreat Surg. 2023 Feb 28;27(1):6-19. doi: 10.14701/ahbps.22-045. Epub 2022 Oct 17.
3
Standardized and Feasible Laparoscopic Approach for Tumors Located in the Caudate Lobe.
标准化且可行的腹腔镜下尾状叶肿瘤入路。
Anticancer Res. 2022 Jul;42(7):3621-3625. doi: 10.21873/anticanres.15850.
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Demonstration of the right-side boundary of the caudate lobe in a liver cast.肝脏铸型中尾状叶右侧边界的显示。
Glob Health Med. 2022 Feb 28;4(1):52-56. doi: 10.35772/ghm.2021.01100.
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Safety and Efficacy of Laparoscopic Caudate Lobectomy: A Systematic Review.腹腔镜尾状叶切除术的安全性与有效性:一项系统评价
J Clin Med. 2021 Oct 24;10(21):4907. doi: 10.3390/jcm10214907.
6
Laparoscopic liver resection for primary liver cancers originating in the paracaval portion of the caudate lobe: a preliminary retrospective analysis with 31 patients.腹腔镜肝切除术治疗起源于尾状叶旁叶的原发性肝癌:31 例初步回顾性分析。
Updates Surg. 2022 Apr;74(2):547-555. doi: 10.1007/s13304-021-01170-9. Epub 2021 Sep 29.
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Robotic isolated partial and complete hepatic caudate lobectomy: A single institution experience.机器人孤立性肝尾状叶部分和完整切除术:单中心经验。
Hepatobiliary Pancreat Dis Int. 2020 Oct;19(5):435-439. doi: 10.1016/j.hbpd.2020.05.003. Epub 2020 May 28.
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