切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2013, Vol. 02 ›› Issue (06) : 358 -362. doi: 10.3877/cma.j.issn.2095-3232.2013.06.003

所属专题： 文献；

临床研究

微创理念下腹腔镜肝切除的现状分析
马渝城1, 严律南1,†()   
  1. 1. 610041　成都，四川大学华西医院肝脏及血管外科
  • 收稿日期:2013-08-12 出版日期:2013-12-10
  • 通信作者: 严律南
  • 基金资助:
    国家科技部十二五重大专项(2012ZX10002-017)

Recent development of laparoscopic liver resection under the concept of minimally invasion

Yu-cheng MA1, Lyu-nan YAN1,†()   

  1. 1. Department of Hepatic and Vascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
  • Received:2013-08-12 Published:2013-12-10
  • Corresponding author: Lyu-nan YAN
  • About author:
    Corresponding author: YAN Lyu-nan, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

马渝城, 严律南. 微创理念下腹腔镜肝切除的现状分析[J]. 中华肝脏外科手术学电子杂志, 2013, 02(06): 358-362.

Yu-cheng MA, Lyu-nan YAN. Recent development of laparoscopic liver resection under the concept of minimally invasion[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2013, 02(06): 358-362.

目的

分析微创理念下腹腔镜肝切除的研究现状。

方法

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。

结果

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。

结论

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。

关键词: 肝切除术, 腹腔镜, 外科手术，微创性, 机器人
Objective

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

Methods

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.

Results

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.

Conclusions

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.

Key words: Hepatectomy, Laparoscopes, Surgical procedures, minimally invasive, Robotics
图1 2003年至2011年腹腔镜肝切除研究文献的发文量时间分布
[1]
Reich H,McGlynn F,DeCaprio J, et al. Laparoscopic excision of benign liver lesions. Obstet Gynecol, 1991, 78(5 Pt 2): 956-958.
[2]
周伟平,孙志宏,吴孟超,等.经腹腔镜肝叶切除首例报道.肝胆外科杂志, 1994, 2(2): 82.
[3]
Lai EC,Tang CN,Yang GP, et al. Multimodality laparoscopic liver resection for hepatic malignancy: from conventional total laparoscopic approach to robot-assisted laparoscopic approach. Int J Surg, 2011, 9(4): 324-328.
[4]
Descottes B,Glineur D,Lachachi F, et al. Laparoscopic liver resection of benign liver tumors. Surg Endosc, 2003, 17(1): 23-30.
[5]
O′Rourke N,Shaw I,Nathanson L, et al. Laparoscopic resection of hepatic colorectal metastases. HPB, 2004, 6(4): 230-235.
[6]
Mala T,Edwin B,Rosseland AR, et al. Laparoscopic liver resection: experience of 53 procedures at a single center.J Hepatobiliary Pancreat Surg, 2005, 12(4): 298-303.
[7]
Vibert E,Perniceni T,Levard H, et al. Laparoscopic liver resection. Br J Surg, 2006, 93(1): 67-72.
[8]
Koffron A,Geller D,Gamblin TC, et al. Laparoscopic liver surgery: shifting the management of liver tumors. Hepatology, 2006, 44(6): 1694-1700.
[9]
Cai XJ,Liang X,Wang YF, et al. Laparoscopic hepatectomy by curettage and aspiration: a new technique. Chin Med J, 2007, 120(20): 1773-1776.
[10]
Dagher I,Proske JM,Carloni A, et al. Laparoscopic liver resection: results for 70 patients. Surg Endosc, 2007, 21(4): 619-624.
[11]
Koffron AJ,Auffenberg G,Kung R, et al. Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg, 2007, 246(3): 385-392.
[12]
江文枢,卢榜裕,蔡小勇,等.腹腔镜肝切除治疗原发性肝癌的探讨（附74例报告）.中国内镜杂志, 2007, 13(12): 1253-1256.
[13]
Topal B,Fieuws S,Aerts R, et al. Laparoscopic versus open liver resection of hepatic neoplasms: comparative analysis of short-term results. Surg Endosc, 2008, 22(10): 2208-2213.
[14]
Bryant R,Laurent A,Tayar C, et al. Laparoscopic liver resection: understanding its role in current practice: the Henri Mondor Hospital experience. Ann Surg, 2009, 250(1): 103-111.
[15]
Ito K,Ito H,Are C,Allen PJ, et al. Laparoscopic versus open liver resection: a matched-pair case control study. J Gastrointest Surg, 2009, 13(12): 2276-2283.
[16]
Wakabayashi G,Nitta H,Takahara T, et al. Standardization of basic skills for laparoscopic liver surgery towards laparoscopic donor hepatectomy. J Hepatobiliary Pancreat Surg, 2009, 16(4): 439-444.
[17]
Otsuka Y,Tsuchiya M,Maeda T, et al. Laparoscopic hepatectomy for liver tumors: proposals for standardization. J Hepatobiliary Pancreat Surg, 2009, 16(6): 720-725.
[18]
Inagaki H,Kurokawa T,Yokoyama T, et al. Results of laparoscopic liver resection: retrospective study of 68 patients. J Hepatobiliary Pancreat Surg, 2009, 16(1): 64-68.
[19]
Zhang L,Chen YJ,Shang CZ, et al. Total laparoscopic liver resection in 78 patients. World J Gastroenterol, 2009, 15(45): 5727-5731.
[20]
Kazaryan AM,Marangos IP,Røsok BI, et al. Laparoscopic resection of colorectal liver metastases: surgical and long-term oncologic outcome. Ann Surg, 2010, 252(6): 1005-1012.
[21]
Cugat E,Pérez-Romero N,Rotellar F, et al. Laparoscopic liver surgery: 8 years of multicenter Spanish register. J Hepatobiliary Pancreat Sci, 2010, 17(3): 262-268.
[22]
Abu Hilal M,Underwood T,Taylor MG, et al. Bleeding and hemostasis in laparoscopic liver surgery. Surg Endosc, 2010, 24(3): 572-577.
[23]
胡明根,刘荣,赵国栋,等.完全腹腔镜肝切除治疗肝脏恶性肿瘤的临床研究[J/CD].中华腔镜外科杂志:电子版, 2010, 3(1): 28-31.
[24]
Ahn KS,Han HS,Yoon YS, et al. Laparoscopic liver resection in patients with a history of upper abdominal surgery. World J Surg, 2011, 35(6): 1333-1339.
[25]
Cannon RM,Brock GN,Marvin MR, et al. Laparoscopic liver resection: an examination of our first 300 patients. J Am Coll Surg, 2011, 213(4): 501-507.
[26]
Giulianotti PC,Coratti A,Sbrana F, et al. Robotic liver surgery: results for 70 resections. Surgery, 2011, 149(1): 29-39.
[27]
Belli G,Fantini C,Belli A, et al. Laparoscopic liver resection for hepatocellular carcinoma in cirrhosis: long-term outcomes. Dig Surg, 2011, 28(2): 134-140.
[28]
张绍庚,陈永标,魏炜明,等.手助腹腔镜大肝肿瘤切除86例[J/CD].中华腔镜外科杂志:电子版, 2010, 3(6): 26-29.
[29]
赵国栋,胡明根,刘荣.模式化腹腔镜肝左外叶切除术：附71例临床应用报道.南方医科大学学报, 2011, 31(4)：737-740.
[30]
Ker CG,Chen JS,Kuo KK, et al. Liver surgery for hepatocellular carcinoma: laparoscopic versus open approach. Int J Hepatol, 2011: 596792.
[31]
Ardito F,Tayar C,Laurent A, et al. Laparoscopic liver resection for benign disease. Arch Surg, 2007, 142(12): 1188-1193.
[32]
Yoon YS,Han HS,Cho JY, et al. Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc, 2010, 24(7): 1630-1637.
[33]
Kaneko H,Otsuka Y,Tsuchiya M, et al. Application of devices for safe laparoscopic hepatectomy. HPB, 2008, 10(4): 219-224.
[34]
Nguyen KT,Gamblin TC,Geller DA. World review of laparoscopic liver resection: 2804 patients. Ann Surg, 2009, 250(5): 831-841.
[35]
王磊,张光永,李涛,等.腹腔镜辅助肝切除术的临床价值.腹腔镜外科杂志, 2011, 16(3)：171-173.
[36]
Eguchi D,Nishizaki T,Ohta M, et al. Laparoscopy-assisted right hepatic lobectomy using a wall-lifting procedure. Surg Endosc, 2006, 20(8): 1326-1328.
[37]
Azagra JS,Goergen M,Gilbart E, et al. Laparoscopic anatomical (hepatic) left lateral segmentectomy-technical aspects. Surg Endosc, 1996, 10(7): 758-761.
[38]
Azagra JS,Goergen M,Brondello S, et al. Laparoscopic liver sectionectomy 2 and 3 (LLS 2 and 3): towards the "gold standard". J Hepatobiliary Pancreat Surg, 2009, 16(4): 422-426.
[39]
Chang S,Laurent A,Tayar C, et al. Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg, 2007, 94(1): 58-63.
[40]
Buell JF,Cherqui D,Geller DA, et al. The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg, 2009, 250(5): 825-830.
[41]
Sasaki A,Nitta H,Otsuka K, et al. Ten-year experience of totally laparoscopic liver resection in a single institution. Br J Surg, 2009, 96(3): 274-279.
[1] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[2] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[3] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[4] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[5] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[6] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[7] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[8] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[9] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[10] 莫波, 王佩, 王恒, 何志军, 梁俊, 郝志楠. 腹腔镜胃癌根治术与改良胃癌根治术治疗早期胃癌的疗效[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 644-647.
[11] 鲁鑫, 许佳怡, 刘洋, 杨琴, 鞠雯雯, 徐缨龙. 早期LC术与PTCD续贯LC术治疗急性胆囊炎对患者肝功能及预后的影响比较[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 648-650.
[12] 孟飞龙, 华帅, 张莹, 路广海. 经脐单孔腹腔镜后鞘后入路在全腹膜外腹股沟疝修补术中的应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 658-660.
[13] 阿冲罗布, 陈颖, 谢德坤. 腹腔镜外囊完整剥离术治疗肝包虫病效果及对患者肝功能、预后的影响[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 666-669.
[14] 索郎多杰, 高红桥, 巴桑顿珠, 仁桑. 腹腔镜下不同术式治疗肝囊型包虫病的临床疗效分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 670-673.
[15] 汤海琴, 郭秀枝, 朱晓素, 赵世娣. “隧道法”腹腔镜解剖性左半肝切除术的临床安全性研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 674-677.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号