Hüscher C G, Lirici M M, Chiodini S
Ospedale San Giovanni, Rome, Italy.
Semin Laparosc Surg. 1998 Sep;5(3):204-10. doi: 10.1177/155335069800500308.
The authors present the rationale of the laparoscopic approach to liver surgery, showing the technique of fully endoscopic and endoscopic-assisted formal and wedge hepatic resections and the early results of their experience. From 1993 to 1997, 38 liver resections have been attempted through the laparoscopic or the laparoscopic assisted approach. Out of these 38 resections, 5 were wedge resections, 11 were segmentectomies, 10 were left formal hepatectomies, 1 was an extended left hepatectomy, 5 were bisegmentectomies, 5 were right formal hepatectomies, and 1 was an extended right hepatectomy. In two cases, one segmentectomy and one bisegmentectomy, the procedures were converted to open surgery. Wedge, segmental, and left liver resections were usually performed through a fully endoscopic approach, whereas right liver resections were accomplished by a video-assisted approach. In all but six cases, the resections were attempted for malignancy. There were no intra-operative deaths. One patient died on postoperative day-1 because of liver failure and severe coagulopathy. The early results are comparable to those of conventional surgery, with the benefits derived from minimal access surgery. Laparoscopic liver resections are technically feasible with an acceptable morbidity and mortality rate, but extensive experience in conventional liver surgery, advanced laparoscopic surgery, and the availability of all requested technology are indispensable prerequisites.
作者介绍了肝脏手术的腹腔镜入路的基本原理，展示了完全内镜及内镜辅助下的规则性肝切除和楔形肝切除技术以及他们的早期经验结果。1993年至1997年期间，通过腹腔镜或腹腔镜辅助入路尝试了38例肝脏切除术。在这38例切除术中，5例为楔形切除术，11例为肝段切除术，10例为左半肝切除术，1例为扩大左肝切除术，5例为双肝段切除术，5例为右半肝切除术，1例为扩大右肝切除术。在两例手术中，1例肝段切除术和1例双肝段切除术中转开腹手术。楔形、肝段及左肝切除术通常通过完全内镜入路进行，而右肝切除术则通过电视辅助入路完成。除6例以外，所有手术均因恶性肿瘤而进行。术中无死亡病例。1例患者术后第1天因肝衰竭和严重凝血功能障碍死亡。早期结果与传统手术相当，具有微创外科手术的优势。腹腔镜肝切除术在技术上是可行的，发病率和死亡率可接受，但传统肝脏手术的丰富经验、先进的腹腔镜手术技术以及所需的所有技术设备是必不可少的前提条件。
