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首页> 外文期刊>Surgical Endoscopy >Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation.
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Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation.

机译：腹腔镜左侧切除术无Pringle手术的演变：通过切除良性和恶性肿瘤，捐献活体肝脏。

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BACKGROUND: Laparoscopic left lateral sectionectomy (LLS) has gained popularity in its use for benign and malignant tumors. This report describes the evolution of the authors' experience using laparoscopic LLS for different indications including living liver donation. METHODS: Between January 2004 and January 2009, 37 consecutive patients underwent laparoscopic LLS for benign, primary, and metastatic liver diseases, and for one case of living liver donation. Resection of malignant tumors was indicated for 19 (51%) of the 37 patients. RESULTS: All but three patients (deceased due to metastatic cancer disease) are alive and well after a median follow-up period of 20 months (range, 8-46 months). Liver cell adenomas (72%) were the main indication among benign tumors, and colorectal liver metastases (84%) were the first indication of malignancy. One case of live liver donation was performed. Whereas 16 patients (43%) had undergone a previous abdominal surgery, 3 patients (8%) had LLS combined with bowel resection. The median operation time was of 195 min (range, 115-300 min), and the median blood loss was of 50 ml (range, 0-500 ml). Mild to severe steatosis was noted in 7 patients (19%) and aspecific portal inflammation in 11 patients (30%). A median free margin of 5 mm (range, 5-27 mm) was achieved for all cancer patients. The overall recurrence rate for colorectal liver metastases was of 44% (7 patients), but none recurred at the surgical margin. No conversion to laparotomy was recorded, and the overall morbidity rate was 8.1% (1 grade 1 and 2 grade 2 complications). The median hospital stay was 6 days (range, 2-10 days). CONCLUSIONS: Laparoscopic LLS without portal clamping can be performed safely for cases of benign and malignant liver disease with minimal blood loss and overall morbidity, free resection margins, and a favorable outcome. As the ultimate step of the learning curve, laparoscopic LLS could be routinely proposed, potentially increasing the donor pool for living-related liver transplantation.
机译：背景：腹腔镜左侧切除术（LLS）在其用于良性和恶性肿瘤的治疗中已广受欢迎。该报告描述了作者使用腹腔镜LLS进行包括活体肝捐赠在内的不同适应症的经验演变。方法：2004年1月至2009年1月，连续37例患者因良性，原发性和转移性肝病接受了腹腔镜LLS检查，其中1例接受了活体肝捐赠。 37例患者中有19例（51％）接受了恶性肿瘤切除术。结果：除三名患者（因转移性癌症疾病而死亡）之外，所有患者均存活并且在中位随访期为20个月（8-46个月）后良好。肝细胞腺瘤（72％）是良性肿瘤的主要指征，大肠肝转移（84％）是恶性的首指。进行了1例活体肝捐赠。 16例（43％）曾接受过腹部手术，而3例（8％）接受了LLS联合肠切除术。中位手术时间为195分钟（范围为115-300分钟），中位失血为50毫升（范围为0-500毫升）。 7例（19％）出现轻度至严重脂肪变性，11例（30％）出现非特异性门脉炎症。所有癌症患者的中位自由边缘中位数均为5毫米（范围为5-27毫米）。大肠肝转移的总体复发率为44％（7例），但在手术边缘均未复发。没有记录到开腹手术，总发病率为8.1％（1级1级和2级2级并发症）。中位住院时间为6天（范围2-10天）。结论：无门静脉钳夹的腹腔镜LLS可以安全地用于良性和恶性肝病患者，出血量和总发病率极低，游离切除余量小，预后良好。作为学习曲线的最终步骤，可以常规提出腹腔镜LLS，这可能会增加与生活相关的肝移植的供体库。

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