단일 기관에시 시행한 복강겅 간 절제술의 경험

Laparoscopic Liver Resection: A Single Center Experience

  • 김호현 (전남대학교 의과대학 외과학 교실) ;
  • 성진식 (전남대학교 의과대학 외과학 교실) ;
  • 허영회 (전남대학교 의과대학 외과학 교실) ;
  • 고양석 (전남대학교 의과대학 외과학 교실) ;
  • 김정철 (전남대학교 의과대학 외과학 교실) ;
  • 조철균 (전남대학교 의과대학 외과학 교실) ;
  • 김현종 (전남대학교 의과대학 외과학 교실)
  • Kim, Ho-Hyun (Department of Surgery, Chonnam National University Medical School) ;
  • Sung, Jin-Sik (Department of Surgery, Chonnam National University Medical School) ;
  • Hur, Young-Hoe (Department of Surgery, Chonnam National University Medical School) ;
  • Koh, Yang-Seok (Department of Surgery, Chonnam National University Medical School) ;
  • Kim, Jung-Chul (Department of Surgery, Chonnam National University Medical School) ;
  • Cho ,Chol-Kyoon (Department of Surgery, Chonnam National University Medical School) ;
  • Kim, Hyun-Jong (Department of Surgery, Chonnam National University Medical School)
  • 발행 : 2009.09.30

초록

Background : An increasing number of small prospective studies have been published, since the first report of laparoscopic liver resection by Gagner et al. in 1992. They have shown encouraging results for the feasibility and safety of the procedure. This paper provides a retrospective analysis of a single center's experience with elective laparoscopic liver resections. Methods : We did a retrospective study on laparoscopic liver resections performed from July 2005 to April 2009, undertaken in 34 patients with preoperative diagnosis of a benign lesion (7 cases, 20.6%), hepatocellular carcinoma in absence 아 complicated cirrhosis (18 cases, 52.9%), or liver metatasis (9 cases, 26.4%). The mean tumor size was 2.63${\pm}$1.57 cm (range 0.55-7.5). Results: We carried out 15 wedge resections (44.1%), 3 right hemi-hepatectomies (8.8%), 4 left hemi-hepatectomies (11.8%), 5 liver segmentectomies (14.7%), 7 left lateral sectionectomies (20.6%). The average duration of an operation was 175.00${\pm}$129.12 minutes. There were 6 patients (15%) in which a conversion to laparotomy was required none of the conversions occurred under emergency situations. Intraoperative transfusion was required for 5 patients (14.7%). Postoperative complications developed in 2 patients (5.8%) (1 intraabdominal abscess, 1 bile leakage). There were no deaths and no reoperations for complications. The mean postoperative hospital stay was 9.9 days. Conclusion : Our experience shows that laparoscopic liver resections, including major hepatectomies, are feasible and safe. Nonetheless, a prospective randomization study with a greater number of cases and longer follow-up is needed before laparoscopic liver resection can be regarded as the gold-standard approach for hepatic lesions.

키워드

참고문헌

  1. Gagner M, Rogula T, Selzer D. Laparoscopic liver resection: benefits and controversies. Surg Clin North Am 2004;84:451-462. https://doi.org/10.1016/j.suc.2003.11.002
  2. Fabiani P, Katkhouda N, Iovine L, Moujel J. Laparoscopic fenestration of biliary cysts. Surg Laparosc Endosc 1991;1:162-165.
  3. Lefor AT, Flowers JL, Laparoscopic wedge biopsy of the liver. Am Coll Surg 1994;178:307-308.
  4. O' Rourke N, Fielding G. Laparoscopic right hepatectomy: surgical technique. J Gatrointest Surg 2004;8:213-216. https://doi.org/10.1016/j.gassur.2003.11.008
  5. Yoon YS, Han HS, Choi YS et. al. Total laparoscopic right posterior sectionectomy for hepatocellular carcinoma. J Laparoendosc Adv Surg Tech A 2006;16:274-277. https://doi.org/10.1089/lap.2006.16.274
  6. Dulucq J, Wintringer P, Stabilini C, Mahajna A. Isolated laparoscopic resection of the hepatic caudate lobe: surgical technique and a report of 2 cases. Surg Laparosc Endosc Percutan Tech 2006;16:32-35. https://doi.org/10.1097/01.sle.0000202183.27042.63
  7. Dulucq JL, Wintringer P, Stabilini C, Berticelli J, Mahaina A. Laparoscopic liver resections: A single center experience. Surg Endosc 2005;19:886-891. https://doi.org/10.1007/s00464-004-2044-3
  8. Yoon YS, Han HS, Shin SH et al. Total laparoscopic liver resection for a metastatic lesion located in the caudate lobe. J Korean Surg Soc 2007;73(4):340-343.
  9. Cai XJ, Yang J, Yu H et al. Clinical study of laparocopic versus open hepatectomy for malignant liver tumors. Surg Endosc 2008;22:2350-2356. https://doi.org/10.1007/s00464-008-9789-z
  10. Kaneko H, Laparoscopic hapatectomy: indications and outcomes. J Hepatobiliary Pancreat Surg 2005;12:438-443. https://doi.org/10.1007/s00534-005-1028-6
  11. Kaneko H, Takagi S, Otsuka Y et al. Laparoscopic liver resection of hapatocellular carcinoma. Am J Surg 2005;189:190-194. https://doi.org/10.1016/j.amjsurg.2004.09.010
  12. Berends FJ, Meijer S, Prevoo W, Bonier HJ, Cuesta MA. Technical considerations in laparoscopic liver surgery. Surg Endosc 2001;15:794-798.
  13. Cherqui D, Husson E, Hammoud R et al. Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 2000;232:753-762. https://doi.org/10.1097/00000658-200012000-00004
  14. Fong Y, Jarnaqin W, Conlon KC, Dematteo R, Douqhertv E, Blumgart LH. Hand-assisted laparoscopic liver resection: lessons from an initial experience. Arch Surg 2000;135:854-859. https://doi.org/10.1001/archsurg.135.7.854
  15. Ker CG, Chen HY, Juan CC et al. Laparoscopic subsegmentectomy for hepatocellular carcinoma with cirrhosis. Hepatogastroenterology 2000;47:1260-1263.
  16. Belli G, Fantini C, D'Agostino A et al. Laparoscopic versus open liver resection for hepatocellular carcinoma in patients with histologically proven cirrihosis: short-and middle-term results. Surg Endosc 2007;21:2004-2011. https://doi.org/10.1007/s00464-007-9503-6
  17. Troisi R, Montalti R, Smeets P et al. The value of laparoscopic liversurgery for solid benign hepatic tumors. Surg Endosc 2008;22:38-44. https://doi.org/10.1007/s00464-007-9527-y
  18. Dagher I, Lainas P, Carloni A et al. Laparoscopic liver resection for hepatocellular carcinoma Surg Endosc 2008;22:372-378. https://doi.org/10.1007/s00464-007-9487-2
  19. Azagra JS, Goergen M, Gigot JF, Schiltz M, Lens V. Laparoscopic Liver Resection (LLR): state of the art. Eur Surg 2006;38(6):378-383. https://doi.org/10.1007/s10353-006-0289-x
  20. Kim CG, Yoon YS. Han HS et al. Experiece of Total Laparoscopic Hepatectomy. J Korean Surg Soc 2007;73(6):490-495.