分析微创理念下腹腔镜肝切除的研究现状。

利用四川大学数字图书馆的Medline（Ovid）数据库、PubMed数据库、中国期刊全文数据库（CNKI），分别使用中文关键词"腹腔镜"、"机器人"、"肝切除"及英文关键词"laparoscopy"、"robot"、"liver resection"、"hepatectomy"检索，辅以文献追溯、手工检索等方法检索相关文献。检索1990年1月至2011年12月发表的关于腹腔镜肝切除研究的国内外文献28篇。腹腔镜肝切除的临床研究内容包括围手术期一般资料（术中平均出血量、输血率、手术中转率、平均手术时间、平均住院时间、并发症发生率、死亡率）、微创手术方式及肝切除术式。采用Excel软件分别对腹腔镜肝切除研究文献的发文量时间分布、发文国家分布、临床研究等方面进行数据分析。

根据腹腔镜肝切除研究文献发文量时间统计，2003年至2011年共3084例，其中2003年至2005年每年文献报道例数在50~100例之间，2006年至2011年报道例数呈上升趋势。2009年至2011年，中、日、韩3国报道文献占同期全世界的50.45%（1018/2018）。截止至2011年12月，我国报道的腹腔镜肝切除例数占全世界的20.04%（618/3084），仅次于美国的28.31%（873/3084）。术中平均出血量为58~700 ml，输血率为0%~25.25%。手术过程中有151例中转为开腹手术，手术中转率为4.90%（151/3084）；中转病例多发生在开展此类手术的早期。平均手术时间为75.0~279.8 min，平均住院时间为1.9~17.0 d。手术并发症发生率为11.25%（347/3084）。围手术期死亡率为0.39%（12/3084）。在统计的28篇文献中，行单纯腹腔镜肝切除2361例，手辅助腹腔镜肝切除541例，腹腔镜辅助肝切除97例和机器人系统肝切除85例。约80%的左外叶切除是在腹腔镜下完成的，仅约18%的左半肝和11%的右半肝切除是在腹腔镜下完成的。2006年至2008年共报道尾状叶切除18例，2009年至2011年仅8例。

微创理念下的腹腔镜肝切除正在世界范围内，尤其在亚洲地区逐渐被广泛应用于临床。与传统开腹肝切除相比，腹腔镜肝切除的术中出血量更少、住院时间更短、并发症发生率及死亡率更低，是一种安全、可行的手术方式。

To analyze the recent research of laparoscopic liver resection under the concept of minimally invasion.

The relevant literature was searched using Chinese and English key words "laparoscopy" , "robot" , "liver resection" and "hepatectomy" in Medline (Ovid), PubMed, China National Knowledge Infrastructure (CNKI) data base in the Digital Library of Sichuan University with the assistance of retrospective literature, manual retrieval. Twenty-eight papers about research on laparoscopic liver resection from January 1990 to December 2011 at home and abroad were searched out. The clinical research content of laparoscopic liver resection included perioperative general information (the average operative blood loss, transfusion rate, surgical conversion rate, average length of operation, average length of hospital stay, incidence of complications, mortality), minimally invasive procedures and liver resection procedures. The publication time distribution, publication nation distribution, clinical studies of literature about laparoscopic liver resection research were analyzed using the software Excel.

According to the publication time of literature about laparoscopic liver resection research, 3804 cases were reported from 2003 to 2011. From 2003 to 2005, among 50 to 100 cases were reported each year, and the number began to grow from 2006 to 2011. From 2009 to 2011, the literature published by Chinese, Japanese and Korean researchers accounted for 50.45% (1018/2018) of the world′s in that period. By December 2011, laparoscopic liver resection cases reported in our country accounted for 20.04% (618/3084), which was next to America [28.31%(873/3084)]. The average operative blood loss was 58-700 ml. The transfusion rate was 0%-25.25%. There were 151 cases converted to laparotomy with a conversion rate of 4.90% (151/3084) during the operation. The conversion mostly occurred in the early period when such operations were launched. The average length of operation was 75.0-279.8 min. The average length of hospital stay was 1.9-17.0 d. The incidence of complications was 11.25% (347/3084). The perioperative mortality was 0.39% (12/3084). In the 28 papers reported, 2361 cases underwent single laparoscopic liver resection, 541 cases underwent hand-assisted laparoscopic liver resection, 97 cases underwent laparoscopic-assisted liver resection and 85 cases underwent robotic-assisted laparoscopic liver resection. About 80% left lateral lobectomies were performed by laparoscopy, while only 18% left hemihepatectomies and 11% right hemihepatectomies were performed by laparoscopy. A total of 18 caudate lobectomies were reported from 2006 to 2008, and only 8 cases were reported from 2009 to 2011.

Laparoscopic liver resection under the concept of minimally invasion has gradually been widely applied in clinic around the world especially in Asian region. Compared with the traditional open liver resection, laparoscopic liver resection possesses advantages of less intraoperative blood loss, shorter length of hospital stay, lower incidence of complications and mortality. It is a safe and feasible surgical procedure.