肝臟惡性腫瘤的微創手術治療

Laparoscopic Hepatectomy for Hepatic Malignancy

陳國鋅(Kuo-Hsin Chen) ； 黃實宏(Shih-Horng Huang)

《台灣癌症醫學雜誌》 26卷5期 (2010/10) Pp. 15-20

https://doi.org/10.6323/JoCRP.2010.26.5.3

摘要

腹腔鏡肝切除是微創手術領域最晚發展的，自M.Gagner於1992年首次報告以來，常被認為技巧上太困難，耗時太久，常常必須改為剖腹手術，因此只有少數外科醫採行。術中出血、可能的氣體栓塞，解剖複雜，缺乏有效的肝實質切開工具等都是推廣腹腔鏡肝切除的障礙。然而近半年來，隨著經驗累積，越來越多的文獻報告成功的腹腔鏡肝切除經驗，多數比較研究顯示微創肝切除有較少的術中出血，住院天數較短、傷口併發症較少等優點。在本文中，筆者將嘗試去回顧現今可行的腹腔鏡切肝方法及治療惡性肝腫瘤的成績。

關鍵字

腹腔鏡肝切除 ； 肝細胞癌 ； 轉移性肝惡性腫瘤

並列摘要

Laparoscopic hepatectomy for malignant tumors is the last frontier in minimally invasive surgery. Since its introduction by Gagner in 1992, the progress of laparoscopic hepatectomy has been slow and only gained minor acceptance among hepatic surgeons. This approach has been regarded to be technique-demanding and time-consuming and to have a high conversion rate. The risk of intraoperative bleeding and air embolism and lack of effective parenchymal transaction tools were all obstacles to widespread use of this approach. However, an increasing body of literature has reported successful experiences with laparoscopic hepatectomy for benign as well as for malignant hepatic tumors. Some series reported decreased blood loss, fewer wound complications and shorter hospital stay after laparoscopic hepatectomy. In this review, we will review current publications on laparoscopic hepatectomy and discuss available laparoscopic hepatectomy techniques, indications and results.

並列關鍵字

Laparoscopic hepatectomy ； Hepatocellular carcinoma ； metastatic liver malignancy