Laparoscopy-Assisted Major Liver Resections Employing A Hanging Technique The Original Procedure
Laparoscopy-Assisted Major Liver Resections Employing A Hanging Technique The Original Procedure
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DOI：
10.1097/sla.0b013e3181cf87da
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发表时间：
2010-03-01
影响因子：
9
通讯作者：
Wakabayashi, Go
中科院分区：
文献类型：
--
作者：
Nitta, Hiroyuki;Sasaki, Akira;Wakabayashi, Go
目的：评估腹腔镜辅助肝大部切除术的可行性、安全性和短期效果。背景资料摘要：腹腔镜肝大部切除术的报道逐渐增多，最近也进行了活体肝切除术进行肝移植。然而，由于对熟练程度的要求很高，大型肝切除术尚未普及。我们开发了一种原创手术，其中通过腹腔镜移动肝脏并通过小切口悬挂技术切除。方法：2002年11月至2008年12月期间，43名患者在我们机构接受了腹腔镜辅助肝脏大部切除术（LAMLR），治疗肝细胞癌、转移性肝癌和良性疾病。结果：LAMLR 42 名患者 (97.7%) 完成了这项工作。中位年龄为 62 岁（范围：24-83 岁）。术前诊断为肝细胞癌（n = 15）、转移性肝癌（n = 19）和良性疾病（n = 8）。肝切除类型包括：右三段切除术（n = 2）、右肝切除术（n = 14）、左肝切除术（n = 16）、三段切除术4、5、8（n = 2）、右前段切除术（n = 4）和扩大右后段切除术（n = 4）。中位手术时间为 317 分钟（范围：192-542 分钟），中位失血量为 631 mL（范围：68-2785 mL）。没有围手术期死亡，也没有再次手术。 5 名患者（11.9%）出现术后并发症，2 名患者（4.8%）出现胆漏，3 名患者（7.1%）出现伤口感染。术后住院时间中位数为13.5天（范围：6-154天）。结论：采用悬挂技术的LAMLR可以安全完成。该手术可由开腹肝外科医生进行；因而在未来可能会得到广泛的应用。
Objective: To assess the feasibility, safety, and short-term outcomes of laparoscopy-assisted major liver resections.Summary of Background Data: The number of reports of laparoscopic major hepatectomies has gradually increased, and living donor hepatectomies for liver transplant have also recently been performed. However, because of the high degree of proficiency required, major hepatectomies have not been widespread. We developed an original procedure in which the liver is mobilized laparoscopically and resected by a hanging technique through a small incision.Methods: Between November 2002 and December 2008, 43 patients underwent laparoscopy-assisted major liver resections (LAMLRs) in our institution for hepatocellular carcinoma, metastatic liver cancer, and benign diseases.Results: LAMLRs were completed for 42 patients (97.7%). The median age was 62 years (range: 24-83 years). Preoperative diagnoses were hepatocellular carcinoma (n = 15), metastatic liver cancer (n = 19), and benign disease (n = 8). The types of liver resection consisted of the following: right trisectionectomy (n = 2), right hepatectomy (n = 14), left hepatectomy (n = 16), trisegmentectomy 4, 5, 8 (n = 2), right anterior sectionectomy (n = 4), and extended right posterior sectionectomy (n = 4). The median operating time was 317 minutes (range: 192-542 minutes) and median blood loss was 631 mL (range: 68-2785 mL). There were neither perioperative deaths nor reoperations. Five patients (11.9%) experienced postoperative complications, 2 patients (4.8%) showed bile leakage, and 3 patients (7.1%) developed wound infections. The median postoperative hospital stay was 13.5 days (range: 6-154 days).Conclusions: LAMLR with the hanging technique can be completed safely. The procedure can be performed by open liver surgeons; and thus may be widely performed in the future.