Wu J S, Strasberg S M, Luttmann D R, Meininger T A, Talcott M R, Soper N J
Department of Surgery, Section of Hepatobiliary Pancreatic Surgery, Washington University School of Medicine, One Barnes Hospital Plaza, St. Louis, MO 63110, USA.
Surg Endosc. 1998 Mar;12(3):232-5. doi: 10.1007/s004649900641.
To date, there have been only a few anecdotal reports of laparoscopic hepatectomy, most of which are limited to wedge resections. The aim of this study was to assess the feasibility of laparoscopic hepatic lobectomy in a porcine model.
Eight pigs were anesthetized before placement of an abdominal wall lift device and five laparoscopic ports. With the porta hepatis clamped, the left lateral hepatic lobe was divided with an ultrasonic dissector. Small vessels and ducts were clipped, larger vascular structures were transected with staplers, and surface hemorrhage was controlled with an argon beam coagulator. Serum liver enzymes (LFTs) and blood counts were drawn pre- and postoperatively. All animals were killed after 1 week.
Mean +/- SEM operating and clamp times were 131 +/- 8 and 39 +/- 2 min, respectively. There were four intraoperative complications in three animals (three lacerations of the hepatic vein and one tear of the splenic capsule), all of which were controlled at surgery. Mean blood loss was 189 +/- 52 ml, and the mass of the resected specimen was 139 +/- 11 g. There were no postoperative complications or deaths. White blood cell count, hematocrit, and LFTs did not change postoperatively, except for aspartate aminotransferase (AST), which was elevated transiently. There were no bile leaks or intraabdominal abscesses.
Laparoscopic left hepatic lobectomy was technically feasible in the porcine model using an abdominal wall lift device for exposure. Clinical trials are needed to assess its feasibility and limitations before laparoscopic hepatic lobectomy is deemed safe for human use.
迄今为止，关于腹腔镜肝切除术仅有少数个案报道，其中大多数局限于楔形切除术。本研究的目的是评估在猪模型中进行腹腔镜肝叶切除术的可行性。
八头猪在放置腹壁提升装置和五个腹腔镜端口前进行麻醉。在肝门阻断的情况下，用超声分离器分离左外侧肝叶。小血管和胆管用夹子夹闭，较大的血管结构用吻合器切断，表面出血用氩气刀控制。术前和术后抽取血清肝酶（肝功能指标）和血细胞计数。所有动物在1周后处死。
平均手术时间±标准误和阻断时间分别为131±8分钟和39±2分钟。三只动物出现了四项术中并发症（三条肝静脉撕裂和一条脾包膜撕裂），所有这些并发症在手术中均得到控制。平均失血量为189±52毫升，切除标本的质量为139±11克。无术后并发症或死亡。术后白细胞计数、血细胞比容和肝功能指标均未改变，但天冬氨酸转氨酶（AST）有短暂升高。无胆漏或腹腔内脓肿。
在猪模型中使用腹壁提升装置暴露肝脏，腹腔镜左肝叶切除术在技术上是可行的。在腹腔镜肝叶切除术被认为对人类使用安全之前，需要进行临床试验以评估其可行性和局限性。
