Laparoscopy and laparoscopic ultrasonography avoid exploratory laparotomy in patients with hepatocellular carcinoma
Laparoscopy and laparoscopic ultrasonography avoid exploratory laparotomy in patients with hepatocellular carcinoma
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DOI：
10.1097/00000658-199804000-00013
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发表时间：
1998-04-01
影响因子：
9
通讯作者：
Wong, J
中科院分区：
文献类型：
--
作者：
Lo, CM;Lai, ECS;Wong, J
本前瞻性研究评估腹腔镜和腹腔镜超声检查（USG）在肝细胞癌（HCC）患者中避免剖腹探查的价值。背景资料腹腔镜和术中USG是确定HCC可切除性的金标准。没有姑息可以提供给患者发现有不可切除的疾病，手术探查的原因morbidity.MethodsFrom 1994年6月至1996年6月，110 370例（30%）HCC被认为是候选人可能肝切除术。术前肝功能采用Child-Pugh分级和吲哚菁绿色滞留试验进行评估。通过放射学检查（包括经皮超声造影、计算机断层扫描和肝血管造影）评估疾病的程度。19例患者因既往上腹部手术（n = 12）、肿瘤破裂（n = 4）、患者拒绝（n = 2）和器械故障（n = 1）而被排除在研究之外。对91例患者在计划进行旨在肝切除的剖腹手术前立即进行腹腔镜和腹腔镜USG。腹腔镜检查时发现不可切除的疾病的明确证据时，剖腹手术被中止。ResultsThe中位时间腹腔镜检查和腹腔镜USG所需的时间为30分钟（范围，10至120分钟）。15例患者在腹腔镜检查中有不可切除疾病的证据。76例行开腹手术，9例行单纯探查，67例行肝切除。因此，63%的不可切除疾病患者避免了剖腹探查术。当肿瘤直径>10 cm时，腹腔镜检查未能确认不可切除的疾病更常见。该程序准确地评估了肝脏残留的充分性和肝内转移的存在，但在确定主要血管结构中肿瘤血栓的存在和邻近器官的浸润程度方面不太敏感。当不可切除的疾病被发现，而不需要剖腹手术，术后恢复更快，和非手术治疗的肿瘤可以开始earlier. ConclusionsLaparoscopic USG避免不必要的剖腹手术在HCC患者，并应提前计划剖腹手术，旨在肝切除术。
ObjectiveThis prospective study evaluates the value of laparoscopy and laparoscopic ultrasonography (USG) in avoiding exploratory laparotomy in patients with hepatocellular carcinoma (HCC).Summary Background DataLaparotomy and intraoperative USG is the gold standard to determine the resectability of HCC. No palliation can be offered to patients found to have unresectable disease, and the surgical exploration causes morbidity.MethodsFrom June 1994 to June 1996, 110 of 370 patients (30%) with HCC were considered candidates for possible hepatic resection. Preoperative liver function was assessed using Child-Pugh grading and indocyanine green retention test. The extent of disease was evaluated with radiologic studies, including percutaneous USG, computerized tomography scan, and hepatic angiogram. Nineteen patients were excluded from the study because of previous upper abdominal surgery (n = 12), ruptured tumors (n = 4), refusal by patients (n = 2), and instrument failure (n = 1). Laparoscopy and laparoscopic USG was performed on 91 patients immediately before a planned laparotomy aiming at hepatic resection. Laparotomy was aborted when definite evidence of unresectable disease was found on laparoscopic examination.ResultsThe median time required for laparoscopy and laparoscopic USG was 30 minutes (range, 10 to 120 minutes). Fifteen patients had evidence of unresectable disease on laparoscopic examination. Among the remaining 76 patients who underwent laparotomy, 9 had exploration only and 67 underwent hepatic resection. Thus, exploratory laparotomy was avoided in 63% of patients with unresectable disease. The laparoscopic examination failed to confirm unresectable disease more often when the tumor was >10 cm in diameter. The procedure accurately assessed the adequacy of the liver remnant and the presence of intrahepatic metastases, but it was less sensitive in determining the presence of tumor thrombi in major vascular structures and the extent of invasion of adjacent organs. When unresectable disease was detected without the need for a laparotomy, the postoperative recovery was faster, and the nonoperative treatment for the tumor could be initialed earlier.ConclusionsLaparoscopy with laparoscopic USG avoids unnecessary laparotomy in patients with HCC and should precede a planned laparotomy aiming at hepatic resection.