中国大陆地区完全腹腔镜肝脏切除术发展及现状：多中心14年经验

目的探讨我国腹腔镜肝脏切除手术的发展、应用情况以及在肝脏肿瘤治疗中的应用情况。方法通过检索解放军医学图书馆中国医院知识仓库医学专题全文数据库（CHKD）、中国生物医学文献光盘数据库（CBMdisc）、中文生物医学期刊数据库（CMCC）、维普医药信息资源系统（VMIS）,从1994年1月至2008年12月全国各级期刊关于腹腔镜肝脏切除的论文,统计来自50个医疗单位733例腹腔镜肝脏切除手术。结果统计显示1994年1月至2008年12月文献报道国内共完成完全腹腔镜下肝脏切除手术735例,其中有具体病种记录的676例,其中包括肝脏恶性肿瘤336例（包含21例肝转移癌）,肝血管瘤144例,肝内胆管结石127例,肝局灶性结节性增生（FNH）31例以及其他肝脏少见疾病38例;经统计行完全腹腔镜下肝脏切除的FNH平均直径（2.889±0.323）cm。结论腹腔镜肝脏切除手术是一项复杂的手术,腹腔镜肝脏切除用于治疗肝脏占位性病变是安全有效的,但此项技术的应用需要丰富的肝脏外科经验以及正规的腹腔镜外科技术培训,同时应合理把握其手术适应证和禁忌证也是同样重要的。

The study on development and current status of totally laparoscopic hepatectomy in china mainland: 14 years experience in multiple institutions

Objective The aim of the present study was to review multiple institutions＇ 14 years experience of totally laparoscopic hepatectomy（TLH）.totally laparoscopic liver resection（TLLR）.Methods A computer-based online search of China Hospital Knowledge Database（CHKD）,China BioMedical Literature on disc（CBMdisc）,Chinese Medical Current Contents（CMCC） and Vip Medical information system（VMIS） was undertaken to identify the articles about TLH published in Chinese from January 1994 to December 2008.Results Between January 1994 and December 2008,733 patients underwent TLH for hepatocellular carcinoma（HCC）（336 cases,including 21 cases of liver metastases） and many kinds of benign liver lesions（397 cases,including hepatic hemangioma,hepatic focal nodular hyperplasia etc.）.Average diameter of HCC,hepatic hemangioma and FNH was 4 cm（range 2～9 cm）,5 cm（range 2～10 cm）and 2 cm（range 1.5～3 cm） respectively.Operations included 364 laparoscopic wedge resections,229 laparoscopic regular hepatectomy and 139 laparoscopic anatomical hepatectomy.Conclusions TLH is a complex laparoscopic surgery and can be performed safely for a variety of malignant and benign liver tumors.The safe and effective application of this technology demands abundant surgical experience of the liver and strict formal training and reasonable grasp of surgical operation indication and contraindication is equally important also.