Laparoscopic hepatic lobectomy in the porcine model
Laparoscopic hepatic lobectomy in the porcine model
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DOI：
10.1007/s004649900641
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发表时间：
1998-03-01
期刊：
影响因子：
--
通讯作者：
Soper, NJ
中科院分区：
文献类型：
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作者：
Wu, JS;Strasberg, SM;Soper, NJ
背景：到目前为止，腹腔镜肝切除术的报道很少，大多数仅限于楔形切除。本研究的目的是评估猪模型中腹腔镜肝叶切除术的可行性。方法：在放置腹壁提升装置和五个腹腔镜端口之前，麻醉八只猪。夹闭肝门，用超声刀分离肝左外叶。夹闭小血管和导管，用吻合器横切较大血管结构，用氩束凝固器控制表面出血。术前和术后抽取血清肝酶（LFT）和血细胞计数。结果：平均+/- SEM操作和钳夹时间分别为131 +/- 8和39 +/- 2 min。三只动物发生了四次术中并发症（三次肝静脉撕裂和一次脾被膜撕裂），所有这些都在手术中得到了控制。平均失血量为189 +/- 52 ml，切除标本的质量为139 +/- 11 g。无术后并发症或死亡。除天门冬氨酸氨基转移酶（AST）一过性升高外，术后白色血细胞计数、红细胞压积和LFT均无变化。有没有胆漏或intrabadernapests.Conclusions：腹腔镜左肝叶切除术在技术上是可行的，在猪模型中使用腹壁升降机装置暴露。在腹腔镜肝叶切除术被认为对人类安全使用之前，需要进行临床试验来评估其可行性和局限性。
Background: To date, there have been only a few anecdotal reports of laparoscopic hepatectomy, most of which are limited to wedge resections. The aim of this study was to assess the feasibility of laparoscopic hepatic lobectomy in a porcine model.Methods: Eight pigs were anesthetized before placement of an abdominal wail lift device and five laparoscopic ports. With the porta hepatis clamped, the left lateral hepatic lobe was divided with an ultrasonic dissector. Small vessels and ducts were clipped, larger vascular structures were transected with staplers, and surface hemorrhage was controlled with an argon beam coagulator. Serum liver enzymes (LFTs) and blood counts were drawn pre- and postoperatively. All animals were killed after 1 week.Results: Mean +/- SEM operating and clamp times were 131 +/- 8 and 39 +/- 2 min, respectively. There were four intraoperative complications in three animals (three lacerations of the hepatic vein and one lear of the splenic capsule), all of which were controlled at surgery. Mean blood loss was 189 +/- 52 ml, and the mass of the resected specimen was 139 +/- 11 g. There were no postoperative complications or deaths. White blood cell count, hematocrit, and LFTs did not change postoperatively, except for aspartate aminotransferase (AST), which was elevated transiently. There were no bile leaks or intraabdominal abscesses.Conclusions: Laparoscopic left hepatic lobectomy was technically feasible in the porcine model using an abdominal wall lift device for exposure. Clinical trials are needed to assess its feasibility and limitations before laparoscopic hepatic lobectomy is deemed safe for human use.