腹腔镜下左半肝切除术

肝内胆管结石是指结石位于肝内胆管。这种疾病在西方不多见而易发于东亚地区,(肝内胆管中的)结石和(或)狭窄等因素使肝内胆管反复发生化脓性感染,不仅加重胆管的狭窄和阻塞,并加重肝实质的损害,导致肝纤维化,萎缩;感染急性发作时又易发生菌血症、感染性休克、胆源性肝脓肿、胆管溃疡致胆道出血,病变晚期则可发生胆汁性肝硬化、门脉高压症等一系列严重的后果。近年来,因为左半肝较容易操作的解剖位置使得腹腔镜下左半肝切除术在肝胆外科手术中很快得到关注,研究和临床经验表明左半肝切除术用于肝胆管结石症,兼具解除肝管梗阻(结石,尤其合并存在的肝胆管狭窄)和去除化脓性感染病灶的双重效果,有效地提高了肝胆管结石的远期治疗效果。     

腹腔镜肝切除术5例报告

目的探讨腹腔镜肝切除的可行性和适应证. 方法 2002年4月～2003年4月,腹腔镜下对5例位于肝脏左外叶的小肝癌进行切除,End-vascular GIA在肿瘤右侧横断肝脏实质,切下的肝组织连同肿瘤组织一同从扩大的切口取出.结果 3例腹腔镜肝切除术成功,2例因分离过程中出血或肝组织太厚中转开腹.腹腔镜下切除的肝脏创面,无渗出,无胆漏.手术时间60～90 min.术后3～5 d出院.无并发症. 结论腹腔镜可切除肝脏左外叶的肿瘤.     

完全腹腔镜下肝左外叶解剖性切除七例

目的探讨完全腹腔镜下肝脏左外叶解剖性切除手术的方法和适应证。方法在不阻断全肝血流的情况下 ,应用多种器械于完全腹腔镜下进行解剖性肝左外叶切除 7例 (男 3例 ,女4例 ) ,其中原发性肝癌 2例 ,肝脏血管瘤 5例 (2例为多发 )。术前 3例行超声和CT检查 ,4例行超声、CT和MRI检查。结果 7例手术均在完全腹腔镜下顺利完成 ,平均手术时间 2 10min ,平均出血量70 0ml,平均输血量 343ml。术后平均住院 5 7d ,腹腔引流管放置时间 2～ 4d。未发生胆漏、出血、感染等并发症。结论在现有的手术器械条件及在不阻断全肝血流的情况下 ,可安全地进行腹腔镜肝左外叶解剖性切除。     

Laparoscopic liver resection: experience of 53 procedures at a single center

Background/Purpose The short-term outcome following laparoscopic liver resection at a single center is presented.Methods Fifty-three procedures were carried out in 47 patients, between August 1998 and April 2004 (6 patients were resected on two occasions). A previous laparotomy and/or hepatectomy had been done in 83% and 26% of the procedures, respectively. Colorectal metastasis was the main indication for treatment (42/53). A total laparoscopic approach was applied.Results Three of the 53 (6%) procedures were converted to laparotomy. In one additional procedure, radiofrequency ablation was done instead of resection. Sixty liver resections were done during the 49 procedures completed laparoscopically as planned (9 patients had concomitant resections performed). Nonanatomic (45/60) and anatomic (15/60; left lobectomies) resections were done. Tumor tissue was found in the resection margins of 6% of the specimens. The free margin was very short in 8% of the specimens. The morbidity was 16%. There was no mortality. Blood transfusions were given following 26% of the procedures. The median hospital stay was 3.5 days (range, 1–14 days) and the median number of days on which there was a need for opioids was 1 (range, 0–11 days).Conclusions Laparoscopic liver resection can be performed safely and seems to offer short-term benefits to the patients. Randomized studies are required to further evaluate the potential benefits of this treatment.     

Laparoscopic liver resection for localized primary intrahepatic bile duct dilatation

Background

Primary intrahepatic bile duct dilatation (IHBD) may present as a localized form in which resection of the affected liver can prevent immediate and late complications. Laparoscopy has gained large interest in liver surgery. It also allows a safe and efficient exploration of the common bile duct.

Methods

We performed 10 laparoscopic liver resections for localized IHBD, on 7 women and 3 men (mean age 47 years). Resections were 2 right hepatectomies, 4 left hepatectomies, and 4 left lateral sectionectomies. Three patients had associated common bile duct stones that were treated through intraoperative cholangioscopy.

Results

The mean operative time was 303.9 minutes. The mean blood loss was 217 mL. None of these patients required hand assistance or conversion to open surgery. One patient suffered a residual collection that was drained percutaneously. The postoperative course was uneventful in the other patients. The mean hospital stay was 5.3 days. No recurrence of cholangitis was observed during the follow-up period.

Conclusions

The laparoscopic treatment of IHBD is safe and should be performed by teams with expertise in both hepatobiliary surgery and laparoscopy.     

Laparoscopic resection of a benign liver tumor in a child

Laparoscopy for the resection of liver masses in children has remained undeveloped despite the wide acceptance of laparoscopy in the field of pediatric surgery. The authors report a case of nonanatomical laparoscopic hepatic resection of a large mesenchymal hamartoma in a 2-year-old boy. The procedure was performed using an innovative approach with a combination of different technologies that allowed for a safe and precise resection. This case demonstrates the feasibility of a nonanatomical laparoscopic hepatic resection, even for very large tumors. Both technical expertise and use of novel technologies are necessary to ensure a precise and controlled resection.     

Laparoscopic liver resection: a systematic review

Background  Outcomes of laparoscopic liver resection (LLR) are not clarified. The objective of this article is to depict the state of the art of LLR by means of a systematic review of the literature. Methods  Studies about LLR published before September 2008 were identified and their results summarized. Results  Indications for laparoscopic hepatectomy do not differ from those for open surgery. Technical feasibility is the only limiting factor. Bleeding is the major intraoperative concern, but, if managed by an expert surgeon, do not worsen outcomes. Hand assistance can be useful in selected cases to avoid conversion. Patient selection must take both tumor location and size into consideration. Potentially good candidates are patients with peripheral lesions requiring limited hepatectomy or left lateral sectionectomy; their outcomes, including reduced blood loss, morbidity, and hospital stay, are better than those of their laparotomic counterparts. The same advantages have been observed in cirrhotics. Laparoscopic major hepatectomies and resections of postero-superior segments need further evaluation. The results of LLR in cancer patients seem to be similar to those obtained with the laparotomic approach, especially in cases of hepatocellular carcinoma, but further analysis is required. Conclusions  Laparoscopic liver resection is safe and feasible. The laparoscopic approach can be recommended for peripheral lesions requiring limited hepatectomy or left lateral sectionectomy. Preliminary oncological results suggest non-inferiority of laparoscopic to laparotomic procedures.     

腹腔镜肝癌切除术15例报告

目的探讨腹腔镜肝癌切除的可行性与适应证. 方法 1998年8月～2004年9月采用多功能手术解剖器(Peng's multifunctional operative dissector,PMOD)刮吸法断肝技术对15例肝癌行腹腔镜肝癌切除术. 结果 14例腹腔镜肝癌切除术成功,1例因术中出血中转开腹肝癌切除术.腹腔镜肝癌切除术手术时间60～240 min,平均125 min.术中出血量50～2 000 ml,平均501 ml.切除肝脏最大体积10 cm×9 cm×7 cm.术后无并发症发生.术后24 h均能下床活动,术后1～3 d即能进食.术后住院5～10 d,平均6.5 d. 结论对位于肝脏边缘、右肝表面或左半肝的恶性肿瘤,采用PMOD行腹腔镜肝癌切除是可行和安全的.     

Laparoscopic liver resections: A single center experience

Background Since the first report of laparoscopic liver resection, by Gagner et al. 1992, an increasing number of small prospective studies have been published. They have shown encouraging results for the feasibility and safety of the procedure. This paper prospectively evaluated the results of a single center’s experience with elective liver resections.Methods From January 1995 to January 2004 a prospective study of laparoscopic liver resections was undertaken in 31 patients with preoperative diagnosis of benign lesions (13 cases, 42.4%), hepatocellular carcinoma in absence of complicated cirrhosis (three cases, 9.1%), and liver metastases (15 cases, 45.5%). Mean tumor size was 34.9 mm (range 10–100 mm).Results The procedures included 11 (37.9%) major hepatectomies and 21 (62.1%) minor resections (one patient was submitted to repeat laparoscopic liver resection) . There were three conversions to open. Mean blood loss was 210 ml (range 0–700 ml). Mean operative time was 115 min (range 45–210 min). There were no deaths and no reoperations for complications. No port-site metastases occurred in patients with malignant lesions.Conclusions Laparoscopic liver resections, including major hepatectomies, are feasible and safe. Major and posterior resections are difficult, though, and conventional surgery remains an option.     

腹腔镜辅助肝切除术的临床价值

目的:探讨腹腔镜辅助肝切除术的临床价值.方法:2005年4月至2010年8月行腹腔镜辅助肝切除术12例,在腔镜下游离肝脏后做辅助切口切除病变.结果:12例手术包括左半肝切除术2例,左外叶切除术6例,第7段切除术2例,右后叶切除术1例,右半肝切除术1例.手术时间2.5～5.5h,术中失血200～1 200ml,平均550...     

腹腔镜肝切除术的临床分析(附5例报告)

目的:探讨腹腔镜肝切除术的可行性。方法:2004年11月~2006年1月我院行完全腹腔镜肝切除5例,其中转移性肝癌2例,肝血管瘤3例。肝功能Ch ild分级A级。结果:5例均在腹腔镜下完成肝局部切除术。手术时间45~280m in,平均143m in。出血量50~800m l,平均402m l。输血量0~600m l,平均175m l。术后恢复顺利,术后住院时间2~9d,平均5.6d。结论:腹腔镜肝切除术安全可行,不仅适于肝良性肿瘤,也为肝脏恶性肿瘤提供了切除肿瘤的新途径。     

腹腔镜技术在肝部分切除术中的临床应用

目的探讨腹腔镜肝部分切除术的方法和应用价值。方法选择经临床筛选的第Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ段或边缘型的肝癌26例、肝海绵状血管瘤9例、左肝外叶胆管内结石10例及肝局灶性结节性增生4例,在腹腔镜下应用电凝、超声刀、切割闭合器等方法断肝,采用钛夹夹闭、缝扎、医用胶粘封等多种对肝断面方法进行处理,完成腹腔镜下肝部分切除术。其中35例在全腹腔镜下完成,13例采用手助下腹腔镜肝部分切除术。结果 49例患者中48例在腹腔镜下成功完成手术,包括左肝外叶切除及肝的非规则切除,手术时间53-145min。手术出血40~700ml,其中1例术中肝内静脉出血达2000ml腔镜下难以控制出血中转开腹手术。术中未出现不能控制的并发症,术后恢复时间较常规开腹的肝切除患者明显缩短。肝癌患者术后随访6~60个月,未发现腹腔及穿刺孔转移。结论在所经过临床选择的病例中,腹腔镜下肝部分切除术是痛苦小、安全、可行的。     

腹腔镜下肝切除术治疗肝内胆管结石(附11例报告)

目的探讨运用腹腔镜技术肝切除治疗肝内胆管结石的可行性。方法回顾性分析我院2005年6月-2007年12月行腹腔镜肝切除的11例肝内胆管结石的临床资料。结果本组11例手术均获得成功,无中转开腹,无术后并发症。平均手术时间（203±53．8）rain,术中平均出血量（189±50．3）ml,病人平均住院时间（7±2．63）d。结论采用腹腔镜肝切除术治疗肝内胆管结石,技术安全可行,并能大大减轻病人的手术创伤。     

腹腔镜肝切除术治疗原发性肝癌九例

目的　探讨腹腔镜肝部分切除术治疗原发性肝癌的方法和应用价值。方法　第Ⅱ、Ⅲ段及Ⅴ、Ⅵ段或边缘型的原发性肝癌9例,在腹腔镜辅助下,应用手助器、超声刀、切割器等特殊器械进行腹腔镜下肝切除术。结果　9例患者均在腹腔镜下完成手术,包括肝Ⅱ、Ⅲ段切除及非规则性肝段切除术,其中2例附加腹腔镜下脾切除术,手术时间80～14 5min ,术后住院6～9d ,手术出血15 0～70 0ml,无中转开腹手术,无并发症。术后随访5～2 5个月,3例分别于手术后3、4及13个月肝内复发,其余6例随访至今无复发。结论　在经过临床选择的病例中,手助腹腔镜下作肝部分切除术治疗原发性肝癌是可行的     

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目的 研究如何完成完全腹腔镜下左半肝切除术。方法 2002年7～12月，在不阻断全肝血流的情况下，应用多种器械行完全腹腔镜下解剖性左半肝切除3例，其中原发性肝癌1例、肝囊肿伴感染1例、肝门部胆管癌1倒。结果 3例手术均在完全腹腔镜下顺利完成，手术时间平均300min，出血量平均267mL。术后平均住院6．3d，腹腔引流管放置时间2～4d。未发生胆漏、出血、感染等并发症。结论 在现有的手术器械条件下，可安全地进行腹腔镜解剖性左半肝切除。该方法可作为病灶局限于左半肝的病例的首选术式之一。     

腹腔镜规则性左肝外侧叶切除术15例

目的探讨腹腔镜左肝外侧叶切除术的可行性。方法2004年12月-2006年8月对病灶位于左肝外侧叶原发性肝细胞癌10例，肝海绵状血管瘤3例，结肠癌肝转移2例，腹腔镜下应用电刀或超声刀、线性切割器等切除左肝外侧叶。结果15例均在完全腹腔镜下行规则性左肝外侧叶切除，无中转开腹。手术时间65—120rain，平均100min；术中出血量50—100ml，平均80ml。肿瘤全部完整切除，无破裂，完整取出标本的边界距肿瘤切缘1cm以上，术后病理证实切端未见癌细胞侵犯。术后无出血及胆漏，术后腹腔引流管3—4d。术后住院3—5d。12例肝癌术后随访1-20个月，平均12．5月，未见肝内复发及手术切口肿瘤种植，所有患者均健康存活。结论腹腔镜规则性左肝外侧叶切除可行、安全。     

腹腔镜肝切除：解剖性与非解剖性利弊之我见

随着腹腔镜手术器械和技术的不断进步,腹腔镜肝切除技术在肝脏良恶性疾病的治疗和肝移植供肝的切取中得到越来越多的应用。依据是否预先解剖和阻断预切除肝脏的入肝和(或)出肝血流,腹腔镜肝切除可分为解剖性和非解剖性肝切除。二者具有各自的适应证和优缺点。本文结合文献和个人经验,对腹腔镜解剖性与非解剖性肝切除的利弊进行论述与讨论。     

腹腔镜左半肝切除治疗肝内胆管结石的临床研究

目的探讨腹腔镜左半肝切除治疗肝内胆管结石的可行性。方法 9例肝胆管结石的病例,经应用电刀、超声刀等断肝方法,肝断面采用腔镜下用肝针缝合,并喷洒生物蛋白胶等处理方法,行腹腔镜左半肝切除术,其中行规则性左半肝切除术2例,不规则性左半肝切除术7例;合并胆囊切除7例。结果 9例病人手术均获得成功,手术时间(289.44±25.05)min;术中出血(308.89±65.28)ml;术后恢复顺利,无并发症,病人住院时间(6.67±1.22)d;残石率0(0/9)。结论腹腔镜左半肝切除治疗肝胆管结石安全、可行,具有微创的优点;可作为治疗肝胆管结石的一种新的选择。     

Laparoscopic liver resection: results for 70 patients

Background Laparoscopy is slowly becoming an established technique for liver resection. This procedure still is limited to centers with experience in both hepatic and laparoscopic surgery. Preliminary reports include mainly minor resections for benign liver conditions and show some advantage in terms of postoperative recovery. The authors report their experience with laparoscopic liver resection, the evolution of the technique, and the results. Methods From 1999 to 2006, 70 laparoscopic liver resections were performed using a procedure similar to resection by laparotomy. Results There were 38 malignant tumors (54%) and 32 benign lesions (46%). The malignant tumors were mainly hepatocellular carcinomas (19 of 24 patients had cirrhosis). The tumor mean size was 3.8 ± 1.9 cm (range, 2.2–8 cm). There were 19 major hepatectomies, 34 uni- or bisegmentomies, and 17 atypical resections. The operative time was 227 ± 109 min. Conversion to laparotomy was required for seven patients (10%), mainly for continuous bleeding during transection. Nine patients (13%) required blood transfusion. One patient had both brisk bleeding and gas embolism from a tear in the section line of the right hepatic vein requiring laparoscopic suture. Blood loss and transfusion requirements were significantly lower in recent than in early cases and in resections with prior vascular control than in those without such control. Postoperative complications were experienced by 11 patients (16%), including one bleed from the hepatic stump requiring hemostasis and two subphrenic collections requiring percutaneous drainage. One cirrhotic patient died of liver failure after resection of a partially ruptured tumor. No ascites was observed in other cirrhotic patients. The mean hospital stay was 5.9 days. Conclusion The study results confirm that laparoscopic liver resection, including major hepatectomies, can be safely performed by laparoscopy. Presented at the 2006 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Meeting, Dallas, Texas, 26–29 April 2006