腹腔镜肝切除术的进展

腹腔镜肝切除(LH)已在全球逐渐开展起来,许多资料显示LH与开放肝切除(OH)相比,可减少术中出血量,降低术后并发症率,减少住院时间.自1992年报告第1例LH以来,全球共施行LH 3000例以上,并发症率10.5%,病死率0.3%.LH可分为全LH、手助LH和杂交LH三类.在开始LH时,使用超声刀和电凝简单器械切除肝脏,那时仅行小的楔状切除、肝囊肿切除和肝活检;但随着技术和器械的改进,目前使用了多种器械,包括超声分离器、血管内吻合器装置、水枪、组织连接器、LigaSure等.且随着经验的积累,目前已能进行大的LH.但LH的关键点仍在于阻断入肝血流和肝实质的离断.

Recent advance in laparoscopic hepatectomy

Laparoscopic hepatectomy (LH) has been an incredible proliferation worldwide. many series have demonstrate that LH decreases intraoperative bleeding, postoperative compliceations and the duration of hospital stay. When compared with open hepatectomy(OP). Since the first LH was reported in 1992, near to 3000 cases have been reported,it's morbidity and mortality are 10. 5% and 0. 3% respectively. There are three terms should be used describe LH: pure laparoscopy, hand-assisted laparoscopy, and hybrid technique. In the beginning of LH, both resections were performed using the ultrasonic dissector and electrocautery,the operation included small wedge resection, liver cyst resection, and liver briopsy, however, while improvements in technology,as harmornic scalpel, endovasculer stapling devices, water jet, LigaSure, TissurLink, Habib etc. With increased experience, surgeons became holder and began to performe larger LH. But the keypoint of LH was use of portal inflow occlusion,and technique of paranchymal transection.