Watanabe Y, Sato M, Ueda S, Abe Y, Iseki S, Horiuchi A, Kashu Y, Kawachi K
Second Department of Surgery, Ehime University School of Medicine, Shigenobu, Japan.
Hepatogastroenterology. 1997 Jan-Feb;44(13):143-7.
HCC is well known for its high incidence of intrahepatic tumor recurrence and many patients suffering from them, usually undergo further treatments, such as PEI, TAE, MCNT or hepatic resection. However, conventional hepatic resection by large skin incision causes severe intraabdominal adhesions, which disturb US examination and further treatments. The aim of the laparoscopic procedure is to prevent intraabdominal adhesions. This is a study of the feasibility of laparoscopic hepatic resection without CO2 pneumoperitoneum, which is not yet popular, as a safe and effective procedure. The patient in this study had a solitary HCC in the lateral segment. Mobilization of the lateral segment, dissections of the left hepatic artery and portal venous branches, i.e. P2 and P3, were performed under CO2 gas insufflation. However, to avoid CO2 gas embolism, further procedures, including parenchymal compression and hepatic venous dissection, were performed using the abdominal wall lifting method without pneumoperitoneum. The patient could eat on the second postoperative day and had an uneventful postoperative recovery and was discharged from the hospital 13 days after surgery. Hospital stay was shorter than conventional hepatic resections with large skin incisions. The importance of this procedure lies in that it is not only a minimally invasive procedure, but also provides us with the possibilities of further treatments, including PEI and re-hepatic resection.
肝癌以肝内肿瘤高复发率而闻名，许多肝癌患者通常需要接受进一步治疗，如经皮乙醇注射（PEI）、经动脉栓塞化疗（TAE）、多极针射频消融（MCNT）或肝切除术。然而，传统的大切口肝切除术会导致严重的腹腔内粘连，干扰超声检查及后续治疗。腹腔镜手术的目的是防止腹腔内粘连。本研究旨在探讨无二氧化碳气腹的腹腔镜肝切除术作为一种安全有效的手术方式的可行性，目前该方法尚未广泛应用。本研究中的患者在肝外侧段有一个孤立性肝癌。在二氧化碳气腹下进行肝外侧段游离、左肝动脉及门静脉分支（即P2和P3）的解剖。然而，为避免二氧化碳气体栓塞，后续操作，包括实质压迫和肝静脉解剖，采用无气腹的腹壁提升法进行。患者术后第二天即可进食，术后恢复顺利，术后13天出院。住院时间比传统大切口肝切除术短。该手术的重要性在于它不仅是一种微创手术，还为我们提供了包括PEI和再次肝切除等进一步治疗的可能性。
