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Purpose : Laparoscopic hepatic resection (LHR) is still a challenging and developing surgical modality because of technical difficulty and a lack of training opportunities and experience. In this stud...y, we present the results of our initial experiences of LHR, focusing on technical evolution in the management of LHR. Methods : Between April 2011 and March 2012, a total of 12 LHRs were performed. The first 5 of these LHRs were performed under laparoscopic assistance (hybrid-LHR), while the last 7 LHRs were performed totally laparoscopically (pure-LHR). Indications for LHR were hepatocellular carcinoma (n = 9) and metastatic liver cancer (n = 3). LHR procedures consisted of partial resection (n = 2), left lateral segmentectomy (n = 2), and left lobectomy (n = 1) in the hybrid-LHR group, and partial resection (n = 4), left lateral segmentectomy (n = 2), and right lobectomy (n = 1) in the pure-LHR group. Operative outcomes were compared between the groups and technical modifications were evaluated. Results : The mean operative time, blood loss, and length of hospital stay in the hybrid- and pure-LHR groups were 3.8 and 6.1 hours, 220 and 611 ml, and 9.4 and 7.4 days, respectively. There were no postoperative complications in both groups. Tumor margins were negative in all cases. Conclusions : LHR is a feasible and effective procedure for patients with various types of liver tumors, although technical challenges still need to be overcome.
【目的】腹腔鏡下肝切除は，未だ発展途上の術式である．今回，当施設における腹腔鏡下肝切除の術式工夫の変遷とその成績を検討した．【方法】2010年４月〜2012年３月までに12 例の腹腔鏡下肝切除：腹腔鏡補助下（Hybirid-LHR）５例，完全腹腔鏡下（Pure-LHR）７例を行った．手術適応はHCC ９例，転移性肝癌３例であった．術式は外側区域切除（n=4：Hybrid-LHR n=2，Pure-LHR n=2），部分切除（n=5：それぞれn=2，n=4)，左葉切除（n=1：Hybrid-LHR n=1），右葉切除（n=1：Pure-LHR n=1）であった．Hybrid-LHR５例は腹腔鏡補助下で肝脱転後，小開腹をおきCUSA，ソフト凝固で直視下に通常の肝切離を行った．Pure-LHR７例では完全腹腔鏡にCUSA，腹腔鏡用ソフト凝固，バイクランプを基本デバイスとして用い通常の開腹肝切離と同様に肝切離を行った．【結果】前半５例と後半７例の平均手術時間3.8 時間vs. 6.1時間，出血量220ml vs. 611ml，術後入院日数9.4 日vs. 7.4 日であった．後半の１例に４単位の輸血を要した．肝切離面の癌浸潤は全例陰性であった．術後合併症は1 例も認めなかった．【結論】腹腔鏡下肝切除はあらゆる腫瘍占拠部位に対して可能であり，有効な手術手技である．続きを見る
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Mendeley出力
