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| 1 | 腹腔镜与开腹肝切除术治疗肝癌疗效的Meta分析显示文摘目的:系统评价腹腔镜肝切除术(LLR)与开腹肝切除术(OLR)治疗肝癌的近、远期疗效和安全性。方法:检索相关期刊、资料、会议文献和学位论文数据库,收集比较LLR与OLR治疗肝癌疗效的病例-对照研究。按MOOSE规范对纳入研究进行分析,提取数据并用Rev Man 5.3软件对数据进行Meta分析。结果:最终共纳入15篇病例-对照研究,共1 246例患者,LLR组499例,OLR组747例。Meta分析结果显示,LLR组与OLR组的手术时间,1、3、5年生存率,1、3、5年无瘤生存率,3年肿瘤复发率组间差异均无统计学意义(均P>0.05);LLR与OLR相比术中出血量少、术后并发症发生率低、围手术期死亡率低、术后住院天数少(均P<0.05)。结论:LLR可以达到与OLR同样的根治效果,两者近、远期疗效无明显差异,且LLR围手术期不良事件少于OLR。 | 佟庆 丁伟 晏冬 王伯庆 薛峰 尹继炜 | 2015 | 中国普通外科杂志2015，24，1： | 34 |
| 2 | Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma显示文摘AIM:To conduct a meta-analysis to determine the safety and efficacy of laparoscopic liver resection(LLR) and open liver resection(OLR) for hepatocellular carcinoma(HCC).METHODS:PubMed(Medline),EMBASE and Science Citation Index Expanded and Cochrane Central Register of Controlled Trials in the Cochrane Library were searched systematically to identify relevant comparative studies reporting outcomes for both LLR and OLR for HCC between January 1992 and February 2012.Two authors independently assessed the trials for inclusion and extracted the data.Meta-analysis was performed using Review Manager Version 5.0 software(The Cochrane Collaboration,Oxford,United Kingdom).Pooled odds ratios(OR) or weighted mean differences(WMD) with 95%CI were calculated using either fixed effects(Mantel-Haenszel method) or random effects models(DerSimonian and Laird method).Evaluated endpoints were operative outcomes(operation time,intraoperative blood loss,blood transfusion requirement),postoperative outcomes(liver failure,cirrhotic decompensation/ascites,bile leakage,postoperative bleeding,pulmonary complications,intraabdominal abscess,mortality,hospital stay and oncologic outcomes(positive resection margins and tumor recurrence).RESULTS:Fifteen eligible non-randomized studies were identified,out of which,9 high-quality studies involving 550 patients were included,with 234 patients in the LLR group and 316 patients in the OLR group.LLR was associated with significantly lower intraoperative blood loss,based on six studies with 333 patients [WMD:-129.48 mL;95%CI:-224.76-(-34.21) mL;P = 0.008].Seven studies involving 416 patients were included to assess blood transfusion requirement between the two groups.The LLR group had lower blood transfusion requirement(OR:0.49;95%CI:0.26-0.91;P = 0.02).While analyzing hospital stay,six studies with 333 patients were included.Patients in the LLR group were found to have shorter hospital stay [WMD:-3.19 d;95%CI:-4.09-(-2.28) d;P < 0.00001] than their OLR counterpart.Seven studies including 416 patients were pooled together to estimate the odds of developing postoperative ascites in the patient groups.The LLR group appeared to have a lower incidence of postoperative ascites(OR:0.32;95%CI:0.16-0.61;P = 0.0006) as compared with OLR patients.Similarly,fewer patients had liver failure in the LLR group than in the OLR group(OR:0.15;95%CI:0.02-0.95;P =0.04).However,no significant differences were found between the two approaches with regards to operation time [WMD:4.69 min;95%CI:-22.62-32 min;P = 0.74],bile leakage(OR:0.55;95%CI:0.10-3.12;P = 0.50),postoperative bleeding(OR:0.54;95%CI:0.20-1.45;P = 0.22),pulmonary complications(OR:0.43;95%CI:0.18-1.04;P = 0.06),intra-abdominal abscesses(OR:0.21;95%CI:0.01-4.53;P = 0.32),mortality(OR:0.46;95%CI:0.14-1.51;P = 0.20),presence of positive resection margins(OR:0.59;95%CI:0.21-1.62;P = 0.31) and tumor recurrence(OR:0.95;95%CI:0.62-1.46;P = 0.81).CONCLUSION:LLR appears to be a safe and feasible option for resection of HCC in selected patients based on current evidence.However,further appropriately designed randomized controlled trials should be undertaken to ascertain these findings. | Jun-Jie Xiong Kiran Altaf Muhammad A Javed Wei Huang Rajarshi Mukherjee Gang Mai Robert Sutton Xu-Bao Liu Wei-Ming Hu | 2012 | World Journal of Gastroenterology2012，18，45： | 25 |
| 3 | Laparoscopic liver resections for hepatocellular carcinoma:Current role and limitations显示文摘Liver resection for hepatocellular carcinoma(HCC)is currently known to be a safer procedure than it was before because of technical advances and improvement in postoperative patient management and remains the first-line treatment for HCC in compensated cirrhosis.The aim of this review is to assess current indications,advantages and limits of laparoscopic surgery for HCC resections.We also discussed the possible evolution of this surgical approach in parallel with new technologies. | Martin Gaillard Hadrien Tranchart Ibrahim Dagher | 2014 | World Journal of Gastroenterology2014，20，17： | 25 |
| 4 | Outcomes of robotic vs laparoscopic hepatectomy:A systematic review and meta-analysis显示文摘AIM: To perform a systematic review and metaanalysis on robotic-assisted vs laparoscopic liver resections.METHODS: A systematic literature search was performed using Pub Med, Scopus and the Cochrane Library Central. Participants of any age and sex, who underwent robotic or laparoscopic liver resection were considered following these criteria:(1) studies comparing robotic and laparoscopic liver resection;(2) studies reporting at least one perioperative outcome; and(3) if more than one study was reported by the same institute, only the most recent was included. The primary outcome measures were set for estimated blood loss, operative time, conversion rate, R1 resection rate, morbidity and mortality rates, hospital stay and major hepatectomy rates.RESULTS: A total of 7 articles, published between 2010 and 2014, fulfilled the selection criteria. The laparoscopic approach was associated with a significant reduction in blood loss and lower operative time(MD = 83.96, 95%CI: 10.51-157.41, P = 0.03; MD = 68.43, 95%CI: 39.22-97.65, P < 0.00001, respectively). No differences were found with respect to conversion rate, R1 resection rate, morbidity and hospital stay.CONCLUSION: Laparoscopic liver resection resulted in reduced blood loss and shorter surgical times compared to robotic liver resections. There was no difference in conversion rate, R1 resection rate, morbidity and length of postoperative stay. | Roberto Montalti Giammauro Berardi Alberto Patriti Marco Vivarelli Roberto Ivan Troisi | 2015 | World Journal of Gastroenterology2015，21，27： | 22 |
| 5 | Laparoscopic liver resection:Experience based guidelines显示文摘Laparoscopic liver resection(LLR) has been progressively developed along the past two decades. Despite initial skepticism, improved operative results made laparoscopic approach incorporated to surgical practice and operations increased in frequency and complexity. Evidence supporting LLR comes from case-series, comparative studies and meta-analysis. Despite lack of level 1 evidence, the body of literature is stronger and existing data confirms the safety, feasibility and benefits of laparoscopic approach when compared to open resection. Indications for LLR do not differ from those for open surgery. They include benign and malignant(both primary and metastatic) tumors and living donor liver harvesting. Currently, resection of lesions located on anterolateral segments and left lateral sectionectomy are performed systematically by laparoscopy in hepatobiliary specialized centers. Resection of lesions located on posterosuperior segments(1, 4a, 7, 8) and major liver resections were shown to be feasible but remain technically demanding procedures, which should be reserved to experienced surgeons. Hand-assisted and laparoscopy-assisted procedures appeared to increase the indications of minimally invasive liver surgery and are useful strategies applied to difficult and major resections. LLR proved to be safe for malignant lesions and offers some short-term advantages over open resection. Oncological results including resection margin status and long-term survival were not inferior to open resection. At present, surgical community expects high quality studies to base the already perceived better outcomes achieved by laparoscopy in major centers' practice. Continuous surgical training, as well as new technologies should augment the application of lap-aroscopic liver surgery. Future applicability of new technologies such as robot assistance and image-guided surgery is still under investigation. | fabricio ferreira coelho jaime arthur pirola kruger gilton marques fonseca raphael leonardo cunha araújo vagner birk jeismann marcos vinícius perini renato micelli lupinacci ivan cecconello paulo herman | 2016 | World Journal of Gastrointestinal Surgery2016，8，1： | 22 |
| 6 | Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease显示文摘Pure laparoscopic hepatectomy is a less invasive procedure than conventional open hepatectomy for the resection of hepatic lesions. Increases in experiences with the technique, in combination with advances in technology, have promoted the popularity of pure laparoscopic hepatectomy. However, indications for usage and potential contraindications of the procedure remain unresolved. The characteristics and specific advantages of the procedure, especially for hepatocellular carcinoma(HCC) patients with chronic liver diseases,are reviewed and discussed in this paper. For cirrhotic patients with liver tumors, pure laparoscopic hepatectomy minimizes destruction of the collateral blood and lymphatic flow from laparotomy and mobilization, and mesenchymal injury from compression. Therefore, pure laparoscopic hepatectomy has the specific advantage of minimal postoperative ascites production that leads to lowering the risk of disturbance in water or electrolyte balance and hypoproteinemia. It minimizes complications that routinely trigger postoperative serious liver failure. Under adequate patient positioning and port arrangement, the partial resection of the liver in the area of subphrenic space, peri-inferior vena cava area or next to the attachment of retro-peritoneum is facilitated in pure laparoscopic surgery by providing good vision and manipulation in the small operative field.Furthermore, the features of reduced post-operative adhesion, good vision, and manipulation within the small area between the adhesions make this procedure safer in the context of repeat hepatectomy procedures.These improved features are especially advantageous for patients with liver cirrhosis and multicentric and/or metachronous HCCs. | Zenichi Morise Norihiko Kawabe Jin Kawase Hirokazu Tomishige Hidetoshi Nagata Hisanori Ohshima Satoshi Arakawa Rie Yoshida Masashi Isetani | 2013 | World Journal of Hepatology2013，5，9： | 21 |
| 7 | 腹腔镜与开腹肝癌切除手术疗效的Meta分析显示文摘目的系统评价腹腔镜与开腹手术切除治疗肝癌的长期疗效及安全性。方法计算机检索PubMed、中国生物医学文献数据库和万方数据库,收集腹腔镜切除与开腹切除比较治疗肝癌的非随机临床对照试验研究。采用Cochrane协作网专用软件RevMan5.1对数据进行统计分析。结果共纳入11个非随机临床对照试验,合计736例患者。Meta分析结果显示:(1)手术时间:8个研究(n=538)的手术时间差异无统计意义[均数差值(MD)=3.05min,95%CI(-14.33,20.42),P=0.73];(2)术中出血量:7个研究(n=461)的术中出血量差异无统计学意义[MD=-167.45mL,95%CI(-334.92,0.03),P=0.05];(3)术中输血率:6个研究(n=457)的术中输血率差异有统计学意义[相对危险度(RR)=0.54,95%CI(0.34,0.85),P=0.008];(4)并发症:10个研究(n=645)并发症的发生率差异有统计学意义[RR=0.55,95%CI(0.41,0.76),P=0.000 2];(5)1、3、5年无瘤生存率:6个研究(n=327)的1、3、5年无瘤生存率差异无统计学意义[RR=1.08,95%CI(0.96,1.22),P=0.20;RR=1.06,95%CI(0.86,1.30),P=0.60;RR=1.06,95%CI(0.82,1.37),P=0.63];(6)1、3、5年生存率:7个研究(n=390)的1、3、5年生存率差异无统计学意义[RR=1.02,95%CI(0.96,1.09),P=0.51;RR=1.12,95%CI(1.00,1.27),P=0.06;RR=1.06,95%CI(0.89,1.27),P=0.50]。结论腹腔镜与开腹手术治疗肝癌比较具有术中输血少、术后并发症发生率低等优点,手术时间、术中出血量、术后1、3、5年生存率和无瘤生存率无差别。 | 罗凤球 何剪太 彭健 陈虎 张阳德 | 2012 | 重庆医学2012，41，24： | 19 |
| 8 | 机器人肝切除技术的优势和弊端显示文摘目的与传统腹腔镜肝切除术配对比较探讨机器人肝切除技术的优势和弊端。方法回顾性分析本中心2009年4月至今连续46例达芬奇机器人手术系统行肝脏部分切除术的病例,统计其术中技术、手术时间、术中出血量及术后恢复情况等临床资料,与本中心同期开展的110传统腹腔镜肝切除术的临床病例资料行对照研究。描述性分析另外10例机器人肝门部胆管癌根治术病例资料。结果除1例机器人肝切除术中转开腹手术,2组病例均为完全腹腔镜下完成手术。传统腹腔镜下采用双主刀技术进行操作。2组病例的平均手术时间差异有统计学意义(P=0.0032),平均失血量无统计学差异(P=0.3470)。2组病例的术后并发症、住院时间等情况对比无统计学差异。机器人肝门部胆管癌技术可行,但手术时间明显较长、出血量大,术后并发症发病率高、住院时间长。结论达芬奇机器人手术系统行精准肝切除术安全可行,由于其稳定性和3D视野尤其利于精准的肝门解剖和腹腔镜下缝合,可以拓展腹腔镜肝切除的适应证。但达芬奇机器人手术系统戳孔布局、器械配合、机械臂对腹腔内外空间的占用严重阻碍助手的操作等原因造成手术难度较大、手术时间延长。另外,机器人手术的费效比较高也阻碍了这一技术的广泛开展。 | 张雯雯 王宏光 纪文斌 卢实春 | 2016 | 肝胆外科杂志2016，24，1： | 16 |
| 9 | 我国腹腔镜和常规肝切除治疗原发性肝细胞肝癌近期及远期疗效比较的META分析显示文摘目的:系统评价国内腹腔镜与开腹手术切除治疗肝癌的近期及远期疗效。方法:计算机检索ISI Web of Knowledge、MEDLINE、EMbase、PubMed,万方数据库、中国知网、维普资讯,收集国内研究机构完成的腹腔镜切除与开腹切除比较治疗肝癌的对照试验。数据提取和文献质量评价由2名评价员独立进行。采用RevMan 5.2对数据进行统计分析。结果:未获得随机对照试验,共纳入10个国内临床同期对照试验,累计病例552例。Meta分析结果显示:1)腹腔镜肝癌切除安全性更佳。可有效减少出血量[WMD=-83.3,95%CI(-124.3,-42.3),P<0.000 1],减少肝门阻断的使用[OR=0.17,95%CI(0.06,0.52),P=0.002],减少术后并发症的发生[OR=0.3,95%CI(0.16,0.59),P=0.000 4],明显缩短住院时间[WMD=-4.85,95%CI(-6.31,-3.38),P<0.000 01]。2)腹腔镜肝癌切除远期疗效无不良影响。腹腔镜与开腹手术组间的肿瘤复发率[OR=1.05,95%CI(0.6,1.85),P=0.87]及1、3、5年总体生存率[OR=1.40,95%CI(0.76,2.56),P=0.28;OR=1.15,95%CI(0.74,1.81),P=0.53;OR=0.91,95%CI(0.57,1.45),P=0.68]和1、3年无瘤生存率[OR=1.89,95%CI(0.96,3.7),P=0.16;OR=1.57,95%CI(0.94,2.61),P=0.18]差异无统计学意义(P>0.05)。结论:对于病变位于CouinaudⅡ、Ⅲ、Ⅳ、Ⅴ及Ⅵ段,肿瘤直径<10 cm,肝功能在Child B级以上的肝细胞癌患者,腹腔镜肝切除术对长期疗效无不良影响,且近期疗效更佳。 | 王立宏 秦成坤 王诚建 王世康 王志意 谢雅琳 | 2014 | 中国现代普通外科进展2014，17，1： | 16 |
| 10 | 腹腔镜与开腹肝切除术比较治疗肝癌的Meta分析显示文摘目的系统评价腹腔镜肝切除术(laparoscopic hepatectomy,LH)与开腹肝切除术(open hepatectomy,OH)治疗肝癌(hepatocellular carcinoma,HCC)的疗效及安全性。方法计算机检索PubMed、EMbase、MEDLINE、SCI、CNKI、CBM、WanFang Data和The Cochrane Library(2012年第3期),收集LH与OH治疗HCC的随机或非随机同期对照试验,检索时限截止到2012年8月。由两名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析。结果纳入13个非随机对照试验,共701例患者。Meta分析结果显示:LH治疗HCC较OH术中出血量少[MD=–144.09,95%C(I–194.25,–93.94),P<0.000 01],住院天数短[MD=–5.48,95%CI(–7.10,–3.85),P<0.000 01],术后并发症少[OR=0.43,95%CI(0.27,0.66),P=0.000 1]。但两组在手术时间[MD=–0.64,95%CI(–22.95,21.68),P=0.96]、围手术期死亡率、3~5年生存率、无瘤生存率等方面差异无统计学意义。结论 LH治疗HCC较OH具有创伤小、术中出血量较少、住院时间短、术后并发症少等特点,并在手术时间、围手术期死亡率、3~5年生存率等方面与OH无明显差异。因此,在严格掌握LH治疗HCC适应证的前提下,采用LH治疗肝癌是安全可行的。由于纳入研究数量和质量存在局限性,上述结论仍需大样本、高质量的RCT进一步验证。临床医生应根据HCC患者的具体情况,综合评估病情,选择最佳的治疗方式。 | 姚刚 曹峻 谷昊 张金辉 阿依甫汗.阿汗 曹新岭 温浩 | 2013 | 中国循证医学杂志2013，13，5： | 13 |
| 11 | 腹腔镜与开腹肝切除术短期疗效的对比研究显示文摘目的评价腹腔镜肝切除术(LLR)与开腹肝切除术(OLR)治疗肝脏良恶性疾病的短期疗效。方法选择实施LLR的患者20例作为LLR组,同期以患者年龄、性别、肝硬化程度、疾病种类、肿瘤大小、手术方式为配对条件在OLR中按1∶1抽选20例作为OLR组。比较两组手术方式、输血例数、平均手术时间、术中平均出血量、术后并发症及恢复情况。结果 LLR组在平均手术时间、术中平均出血量、输血例数、术后首次进食时间、首次下床活动时间及住院时间上均优于OLR组(P<0.05)。结论 LLR在短期疗效方面优于OLR,在严格掌握手术适应证的前提下,前者具有良好的安全可行性。 | 余华 孙建明 朱卓立 刘明忠 赵宇 王翔翔 熊杰 | 2015 | 重庆医学2015，44，22： | 10 |
| 12 | 腹腔镜肝脏肿瘤切除术40例显示文摘目的 探讨腹腔镜肝切除术治疗肝脏肿瘤的可行性及临床应用价值.方法 回顾性分析我院2010年5月至2013年10月期间由同一术者实施的40例腹腔镜肝切除术患者的临床资料,其中原发性肝细胞性肝癌27例,直肠癌肝转移2例,肝脏囊腺瘤2例,肝囊肿1例,肝脏血管瘤5例,肝局灶性结节性增生3例,病灶直径3.0- 10.0 cm,平均(4±4) cm.结果 所有患者均顺利完成手术,无中转开腹及围手术期死亡病例.其中不规则肝切除术21例,肝左外叶切除术12例,左半肝切除术3例,肝Ⅵ段切除术4例.手术时间为75 -265 min,平均(166±109) min,术中出血80-750ml,平均(480±233) ml.其中2例肝细胞性肝癌患者术后病理切缘为阳性.术后1例患者出现胆漏,1例患者出现腹水,均予以保守治疗后康复,术后平均住院(7±14)d.结论 在充分掌握适应证和手术技巧的情况下,腹腔镜肝切除术治疗肝脏肿瘤安全可行. | 汤晓东 刘双海 赵振国 陈胜 | 2014 | 中华普通外科杂志2014，29，10： | 8 |
| 13 | 腹腔镜与开腹手术治疗肝细胞癌的Meta分析显示文摘目的系统评价腹腔镜与开腹手术治疗肝细胞癌的近远期疗效及安全性。方法计算机检索有关腹腔镜与开腹手术治疗肝细胞癌的随机对照试验及临床对照试验的所有英文文献,并采用Cochrane协作网专用软件RevMan 5.1对数据进行统计分析,采用比值比(OR)及其95%可信区间(95%CI)和加权均数(WMD)及其95%CI对结果进行分析。结果未获得随机对照实验,12个病例对照实验被纳入,合计980例患者,其中391例行腹腔镜,589例行开腹手术。Meta分析结果显示:(1)手术时间:两组差异无统计学意义(WMD=3.34,95%CI:-19.17~25.85,P=0.77);(2)术中输血率:腹腔镜组低于开腹手术组,差异有统计学意义(OR=0.48,95%CI:0.26~0.89,P=0.02);(3)术后住院天数:腹腔镜组短于开腹手术组,差异有统计学意义(WMD=-4.27,95%CI:-6.18~-2.37,P<0.0001);(4)术中出血量:腹腔镜组低于开腹手术组,差异有统计学意义(WMD=-242.5,95%CI:-458.67~-26.34,P=0.03);(5)术后并发症发生率:腹腔镜组低于开腹手术组,其差异有统计学意义(OR=0.48,95%CI:0.31~0.75,P=0.001);(6)手术切缘:两组差异无统计学意义(WMD=0.76,95%CI:-0.03~1.56,P=0.06);(7)住院期间病死率:腹腔镜组低于开腹手术组,差异有统计学意义(OR=0.24,95%CI:0.07~0.86,P=0.03);(8)术后1、3年总生存率及1、3、5年无瘤生存率,两组差异无统计学意义(OR=1.09,95%CI:0.70~1.68,P=0.71)(OR=1.31,95%CI:0.95~1.80,P=0.09;OR=1.52,95%CI:0.97~2.37,P=0.07;OR=0.94,95%CI:0.65~1.35,P=0.73;OR=1.14,95%CI:0.75~1.73,P=0.55);(9)术后5年生存率:腹腔镜组高于开腹手术组,差异有统计学意义(OR=1.61,95%CI:1.18~2.19,P=0.003)。结论腹腔镜治疗肝细胞癌作为一种微创手术,与开腹切除术相比,具有创伤小、恢复快、术中出血量少及术后并发症少等优点,腹腔镜肝切除有望成为肝细胞癌患者的首选治疗方案。 | 叶钢 马钰 唐成佳 杜成友 | 2013 | 临床肝胆病杂志2013，29，3： | 6 |
| 14 | 三维医学重建联合达芬奇机器人技术在肝切除术中的临床应用显示文摘目的总结CAS三维医学重建联合达芬奇机器人肝切除术的初步经验。方法回顾性分析我院2014年12月—2019年3月行CAS三维医学重建联合达芬奇机器人肝切除术107例病人的临床资料。结果 107例中105例完成机器人下肝切除术,2例中转开腹,中转率为1.9%。平均手术时间(235.3±35.2)min,术中失血量(144.0±18.6)mL,术中输血比例为9.3%,术后并发症发生率为12.1%,术后住院时间为(7.5±2.3)d。11例肝胆管结石病病人术中结石清除率为95.5%。围手术期无死亡病例。随访时间为2~50个月,平均(21.8±13.0)个月,69例恶性肿瘤中18例复发,其中5例死亡,13例带瘤生存,其余51例健康生存,无复发转移;11例肝胆管结石病人均无复发,2例出现胆管炎症状,接受药物治疗后好转。结论针对性地应用CAS三维医学重建技术有助于肝脏外科疾病病人的术前诊断、手术方式的选择、病灶可切性分析,并可缩短术中决策时间、进行术中指导等,从而降低手术风险。CAS三维医学重建联合达芬奇机器人行肝切除术安全可行、疗效确切,具有微创手术的优势。 | 宋孟锜 李碧露 韩冰 吴泽华 王祖森 邹浩 胡骁 朱呈瞻 徐永政 席跃 孙传东 | 2019 | 精准医学杂志2019，34，2： | 6 |
| 15 | 腹腔镜肝肿瘤切除术疗效研究显示文摘目的 探讨比较腹腔镜肝切除术和开腹肝切除术治疗肝肿瘤的临床疗效。方法 回顾性分析2012年1月-2013年12月该院收治的60例肝癌患者的临床资料。依据手术治疗方案和1∶2配对研究方法将所有患者分为腹腔镜组20例(A组)和开腹组40例(B组)。A组:13例行非规则性肝切除术,7例行规则性肝左外叶切除术,无中转手助式腹腔镜或开腹手术。B组:患者中,29例行非规则性肝切除术,11例行规则性肝切除术。对两组患者的术中平均出血量、术后平均禁食时间、术后平均腹腔引流时间、术后平均住院时间、围手术期肝功能和凝血功能等指标进行统计学分析。结果 各项指标进行比较得出,A组的患者的术中平均出血量(246.12±234.35)mL明显少于B组(407.08±190.14)mL,差异有显著性(0.05)。结论 腹腔镜肝切除术治疗肝癌效果相对安全有效,有助于肝癌患者身体健康的恢复,能够提高肝癌患者的生活质量,值得在临床推广。 | 韩云 杨生虎 李晓峰 杨立平 | 2014 | 中国内镜杂志2014，20，8： | 5 |
| 16 | 腹腔镜下肝切除术的临床疗效及对细胞免疫功能的影响显示文摘目的:分析腹腔镜下肝切除术的临床疗效及对细胞免疫功能的影响。方法:回顾分析97例行肝切除术肝癌患者的临床资料,分为观察组(n=48,行腹腔镜下肝切除术)与对照组(n=49,行开腹肝切除术)。对比两组术中指标、术后近期疗效、远期疗效、并发症发生情况及手术前后不同时间点的外周血淋巴细胞亚群、血清白介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)表达水平。结果:两组转移率、复发率、死亡率、并发症发生率差异均无统计学意义(P>0.05);术后72 h,观察组CD3、CD4、CD8、IL-6、TNF-α表达水平基本恢复至术前水平,对照组CD3、CD4、CD8仍低于术前水平,IL-6、TNF-α仍高于术前水平,差异有统计学意义(P<0.05)。结论:腹腔镜下肝切除术治疗肝癌的临床疗效确切,创伤小,安全性较高,近期疗效优于开腹肝切除术,且对患者的细胞免疫功能影响小,术后康复快。 | 唐彪 欧阳正晟 | 2017 | 腹腔镜外科杂志2017，22，9： | 5 |
| 17 | Laparoscopic liver resection for malignancy:A review of the literature显示文摘AIM: To review the published literature about laparoscopic liver resection for malignancy.METHODS: A PubMed search was performed for original published studies until June 2013 and original series containing at least 30 patients were reviewed.RESULTS: All forms of hepatic resections have been described ranging from simple wedge resections to extended right or left hepatectomies. The usual approach is pure laparoscopic, but hand-assisted, as well as robotic approaches have been described. Most studies showed comparable results to open resection in terms of operative blood loss, postoperative morbidity and mortality.Many of them showed decreased postoperative pain,shorter hospital stays, and even lower costs. Oncological results including resection margin status and long-term survival were not inferior to open resection. CONCLUSION: In the hands of experienced surgeons,laparoscopic liver resection for malignant lesions is safe and offers some short-term advantages over open resection. Oncologically, similar survival rates have been observed in patients treated with the laparoscopic approach when compared to their open resection counterparts. | Eyas Alkhalili Eren Berber | 2014 | World Journal of Gastroenterology2014，20，37： | 5 |
| 18 | 腹腔镜手术与开腹手术在肝细胞癌中应用的Meta分析显示文摘目的评价腹腔镜手术与开腹手术治疗肝细胞癌的疗效及安全性。方法应用循证医学的系统评价方法,对2002年1月至2012年12月在国内外医学期刊发表的有关围术期腹腔镜手术与开腹手术在肝细胞癌中的临床病例对照研究进行质量评价。结果纳入19个病例对照研究的疗效,纳入文献的总体方法学质量较高。Meta分析结果显示,与开腹手术相比较,腹腔镜肝切除术未能显著缩短手术时间(SMD=-0.39,95%CI-0.94^-0.15,P=0.15),减少术中出血量(SMD=-0.76,95%CI-0.92^-0.59,P=0.03),缩短住院时间(SMD=-0.86,95%CI-1.31^-0.98,P<0.00001),减少肛门排气时间(SMD=-0.87,95%CI-1.18^-0.56,P<0.00001)。结论腹腔镜手术能够最大限度地降低手术对患者内环境的影响,患者的出院时间、肛门排气时间均显著少于开腹切除组。 | 朱贤章 丛鹏 韩亚飞 季学闻 赵晋明 | 2014 | 医学综述2014，20，8： | 5 |
| 19 | 腹腔镜与开腹手术治疗肝细胞癌疗效的Meta分析显示文摘目的系统评价腹腔镜与开腹手术治疗肝细胞癌的疗效。方法计算机检索PubMed、中国期刊全文数据库、万方数据库、中国博硕士学位论文数据库及中国重要会议论文数据库2000~2011年发表的有关腹腔镜肝切除术和开腹肝切除术治疗肝细胞癌的相关文献,采用RevMan 5.0进行Meta分析。结果共纳入11项临床对照试验,包括781例患者,其中经腹腔镜手术治疗325例,开腹手术治疗456例。Meta分析结果显示,与开腹手术相比较,腹腔镜肝切除术能明显缩短手术时间〔加权均数差值(WMD)=-20.85,95%CI(-29.54,-12.16),P<0.000 01〕,减少术中出血量〔标准化均数差值(SMD)=-0.42,95%CI(-0.65,-0.19),P=0.000 4〕,降低术后并发症发生率〔优势比(OR)=0.43,95%CI(0.28,0.65),P<0.000 1〕,缩短住院时间〔WMD=-4.32,95%CI(-6.29,-2.34),P<0.000 1〕。但术后复发率(P=0.80)和术后1年总生存率(P=0.98)、3年总生存率(P=0.41)、5年总生存率(P=0.12)以及1年无瘤生存率(P=0.15)、3年无瘤生存率(P=0.62)和5年无瘤生存率(P=0.99)差异均无统计学意义。结论对于病变位于CouinaudⅡ、Ⅲ、Ⅳ、Ⅴ及Ⅵ段,其直径小于5 cm,并且不影响第一和第二肝门血管的暴露,肝功能在Child B级以上的肝细胞癌患者,在条件允许的情况下可优先考虑腹腔镜肝切除术。 | 代景友 杨树萌 张新晨 吴德全 | 2013 | 中国普外基础与临床杂志2013，20，4： | 5 |
| 20 | 腹腔镜下肝部分切除术30例报告显示文摘目的探讨腹腔镜下肝部分切除术的方法和临床应用,总结手术经验。方法回顾分析吉林大学白求恩第一医院自2008年1月至2011年11月期间经临床筛选的位于肝脏左外叶及Ⅵ肝段适合行腹腔镜手术的肝脏肿瘤患者30例,其中男性17例,女性13例;年龄24~68岁,平均年龄41岁。所有患者行腹腔镜肝部分切除术。结果30例患者均成功地在腹腔镜下施行了肝部分切除术,无中转开腹及延长腹壁小切口,手术时间30~60 min,平均手术时间52 min。术中出血量20~200 mL,平均出血量110 mL。术后住院时间4~8 d,平均住院时间6 d。术后未发现并发症。术后病理组织检查证实23例肝细胞癌,7例肝脏血管瘤。结论经过临床选择的病例,腹腔镜肝部分切除术是安全可靠的微创方法,对肝脏边缘型小病灶行完全腹腔镜下病灶切除更具微创意义。 | 刘亚辉 王英超 王广义 纪柏 | 2012 | 生物医学工程与临床2012，16，3： | 4 |
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