腹腔镜肝脏手术。28例患者的报告。
Laparoscopic liver surgery. A report on 28 patients.
作者信息
Marks J, Mouiel J, Katkhouda N, Gugenheim J, Fabiani P
机构信息
Department of Surgery, Allegheny University of the Health Sciences, Hahnemann Division, Philadelphia, PA 19102-1192, USA.
出版信息
Surg Endosc. 1998 Apr;12(4):331-4. doi: 10.1007/s004649900664.
BACKGROUND
An effort was made to evaluate the indications, safety, and therapeutic efficacy of laparoscopic liver surgery.
METHODS
Between 1989 and 1996, 28 patients, 23 to 88 years old were operated upon laparoscopically. Pathology consisted of simple cyst (ten), polycystic liver disease (seven), hydatid cyst (three, two of them calcified), abscess (one), focal nodular hyperplasia (six), and metastatic breast cancer (one).
RESULTS
Operations included 17 fenestrations, three pericystectomies, and eight resections (two lateral lobes). Operative time was 45 to 525 min with only four cases longer than 4 h. There was a 21% morbidity rate. There were no mortalities. Follow-up was 1-67 months with one asymptomatic recurrence.
CONCLUSIONS
Laparoscopic hepatic surgery can be performed safely with good results by surgeons with hepatic and laparoscopic experience when careful selection criteria are followed. We advocate the "four-hands technique" for simultaneous dissection and control of bleeding and bile ducts during resections.
背景
旨在评估腹腔镜肝脏手术的适应证、安全性及治疗效果。
方法
1989年至1996年间，对28例年龄在23至88岁的患者进行了腹腔镜手术。病理类型包括单纯囊肿（10例）、多囊肝（7例）、包虫囊肿（3例，其中2例钙化）、脓肿（1例）、局灶性结节性增生（6例）以及转移性乳腺癌（1例）。
结果
手术方式包括17例开窗引流术、3例囊肿切除术以及8例切除术（2例为肝叶外侧切除术）。手术时间为45至525分钟，仅有4例超过4小时。发病率为21%。无死亡病例。随访时间为1至67个月，有1例无症状复发。
结论
在遵循严格的选择标准时，有肝脏及腹腔镜手术经验的外科医生能够安全地开展腹腔镜肝脏手术，并取得良好效果。我们提倡在切除术中采用“双手技术”以同时进行解剖操作并控制出血和胆管。
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