Yamanaka N, Tanaka T, Tanaka W, Yamanaka J, Yasui C, Ando T, Takada M, Maeda S, Okamoto E
First Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
Hepatogastroenterology. 1998 Jan-Feb;45(19):29-33.
This article describes the surgical techniques and indications of laparoscopic partial hepatectomy, which is not as widely available as laparoscopic cholecystectomy. Three patients with hepatocellular carcinoma and associated severe liver cirrhosis were candidates for this technique from July 1993 to August 1994. The tumor size was 4 cm or less and all the tumors were located in segment 5 or 8 which had grown nodularly and protruded from the liver surface. A microwave tissue coagulator was used for parenchymal dissection under ultrasonographic guidance in a gas-less method with or without low-pressure pneumoperitoteum of 4 mmHg. The principle of dissection consists of tissue coagulation and fragmentation with dissecting forceps. Three hepatectomies were performed uneventfully without blood transfusion and the patients rapidly returned to their preoperative conditions. The laparoscopic partial hepatectomy can be an option of treatment in selected cases where the tumor can be removed by minor, superficial resection.
本文描述了腹腔镜肝部分切除术的手术技术和适应证，该手术的应用不如腹腔镜胆囊切除术广泛。1993年7月至1994年8月，有3例肝细胞癌合并严重肝硬化的患者适合采用该技术。肿瘤大小为4厘米或更小，所有肿瘤均位于5段或8段，呈结节状生长并从肝表面突出。在超声引导下，采用无气法，在有或无4mmHg低压气腹的情况下，使用微波组织凝固器进行实质分离。分离的原则包括用解剖钳进行组织凝固和破碎。3例肝切除术均顺利完成，未输血，患者迅速恢复到术前状态。对于肿瘤可通过较小的浅表切除来切除的特定病例，腹腔镜肝部分切除术可作为一种治疗选择。
