腹腔镜下肝切除进展与初步经验交流.pptVIP

腹腔镜下肝切除 进展与初步经验交流 Progress and Preliminary experience exchange 1992 First laparoscopic liver resection Gagner et al. Surg Endosc 1992; 6: 99. 1996 First anatomic laparoscopic liver resection Azagra et al. Surg Endosc 1996; 10: 758-761. 1997 First laparoscopic major liver resection Huscher et al. J R Coll Surg Edinb 1997; 42: 219-225.  腹腔镜肝切除早期探索 1994 The First Cases in Chinese （Left literal lobetectomy） 周伟平 等. 肝胆外科杂志 1994;2(2): 82-82. 肝切除的迅速发展 2004 2005 2006 2007 2008 澳大利亚布里斯班皇家医院的Nicbolas等 对12例患者试行了腹腔镜下右半肝切除术， 其中5例获得成功，是当时国际上唯一的一组多病例报道。 腹腔镜右半肝切除的报道不断增多，手术时间逐渐缩短，中转开腹率显著降低。 Dulucq等 首次报道了2例腹腔镜下肝尾状叶切除术，鉴于腹腔镜下很难将右肝完全翻转显露尾状叶，他们采用左侧人路，辅以术中超声，很好地避免了因部分不可视操作可能导致的下腔静脉及Ⅳ段和Ⅶ段血管的损伤，2例患者手术过程和术后恢复情况均令人满意。手术的成功实施打破了I段、Ⅶ段及Ⅷ段不是腹腔镜肝切除术适应证这一传统观念，也成为腔镜外科医师开始全面探索特殊部位肝切除术的里程碑。经过近几年的探索，开展腹腔镜下I段、Ⅶ段及Ⅷ段肝切除术的单位逐渐增多，技术日趋完善 。 Kofron等 报道300例腹腔镜肝切除术，其中右半肝切除64例(全腹腔镜29例，手助式12例，腹腔镜辅助23例)，右三叶肝切除术8例均为手助式。 首先报道全腹腔镜下超左半肝切除术治疗左肝原发性肝癌，患者迄今健康存活 。 Gumbs等成功实施了5例全腹腔镜下超右半肝切除术，针对不同情况决定是否部分保留1Va或1Vb段及其相应的肝中静脉属支，尽可能保留了剩余肝脏的功能。同年，他们首次以手术录像形式报道了全腹腔镜解剖性中肝(Ⅳ、V、Ⅷ段)切除术的技术方法 In Those Years 127 published articles of original series on laparoscopic liver resection were identified A total of 2,804 cases of laparoscopicliver resection reported in the literature. wedge resection or segmentectomy (45%) anatomic left lateral sectionectomy (20%), right hepatectomy(9%), left hepatectomy (7%). Conversion laparoscopy to open laparotomy 4.1% laparoscopy to hand-assisted approach 0.7% Morbidity and mortality are10.5% and 0.3%, respectively In experienced hands, laparoscopic liver resections are safe with acceptable morbidity and mortality for both minor and major hepaticresections. Benign 45% Malignant 50% In Those Years Currently acceptable indications: solitary lesions, 5 cm or less, located in liver segments 2 to 6 left lateral sectionectomy should be considered standard practice. Major liver resections should be reserved for experienced surgeons Con