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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.

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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