Laparoscopic Transabdominal With Transdiaphragmatic Access Improves Resection of Difficult Posterosuperior Liver Lesions
Laparoscopic Transabdominal With Transdiaphragmatic Access Improves Resection of Difficult Posterosuperior Liver Lesions
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DOI：
10.1097/sla.0000000000001015
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发表时间：
2015-08-01
影响因子：
9
通讯作者：
Gayet, Brice
中科院分区：
文献类型：
--
作者：
Ogiso, Satoshi;Conrad, Claudius;Gayet, Brice
目的：我们描述了技术细节，并评估了腹腔镜下联合侧腹（CLA）入路切除肝7段和8段的安全性、可行性和有效性。背景：腹腔镜下切除肝7段和8段后上方区域的病变在技术上具有挑战性，目前还没有标准的腹腔镜入路。通过回顾前瞻性维护的数据库，我们确定了44例接受腹腔镜切除第7或第8节段病变的患者。25例患者需要CLA入路，因为他们的病变更多位于后上方和脑实质内; 19例患者接受了常规的仅经腹入路切除更容易进入的前下方病变。我们回顾了这些手术的手术细节和录像，并比较了两组的结果。（88% vs 42%; P = 0.035），中位肿瘤直径较大（24.5 mm vs 15 mm; P = 0.114），切除的软组织的中位重量更大（56.5 g vs 23 g; P = 0.093）。CLA入路组的中位手术时间较长（217.5分钟vs 165分钟; P = 0.046），但失血量、转为开放手术率、手术切缘状态、发病率和死亡率在两组之间相似。CLA入路允许安全的腹腔镜切除第7和第8节段后上区域的病变，允许外科医生克服有限的可视化和接近目标病变的困难。
Objective: We describe the technical details and evaluate the safety, feasibility, and usefulness of a combined lateral and abdominal (CLA) approach for laparoscopic resection of liver segments 7 and 8.Background: Laparoscopic resection of lesions in the posterosuperior area of segments 7 and 8 is technically challenging, and currently there is no standardized laparoscopic approach.Methods: Through review of a prospectively maintained database, we identified 44 patients who underwent laparoscopic resection of lesions in segment 7 or 8. Twenty-five patients required the CLA approach because their lesions were more posterosuperior and intraparenchymal; 19 patients underwent resection with a regular abdominal-only approach of more accessible anteroinferior lesions. We reviewed operative details and video footage of these operations and compared the outcomes of the 2 groups.Results: In the group treated with the CLA approach, deep location was more frequent (88% vs 42%; P = 0.035), median tumor diameter was larger (24.5 mm vs 15 mm; P = 0.114), and the median weight of the excised parenchyma was greater (56.5 g vs 23 g; P = 0.093). Median operative time was longer in the CLA approach group (217.5 minutes vs 165 minutes; P = 0.046), but blood loss, rate of conversion to open surgery, surgical margin status, morbidity, and mortality were similar between the 2 groups.Conclusions: The CLA approach permits safe laparoscopic resection of lesions in the posterosuperior area of segments 7 and 8, allowing surgeons to overcome the difficulties of limited visualization and access to the target lesions.