Reich first reported laparoscopic liver tumor resection in 1991, and with the accumulation of experience in laparoscopic liver surgery, the continuous improvement of operating skills, and the emergence of new laparoscopic-specific instruments and equipment, the application of laparoscopic hepatectomy (LH) in the treatment of primary liver cancer has developed rapidly and shown good The application of Laparoscopic Hepatectomy (LH) in the treatment of primary hepatocellular carcinoma is developing rapidly and showing good efficacy.
1. Advantages of laparoscopic hepatectomy.
① Small incision in the abdominal wall and less damage.
② Less postoperative pain, which is conducive to early activity; less influence on intestinal function, which can be fed at an early stage, and earlier recovery and shorter hospitalization time.
③ Postoperative hepatocellular carcinoma often requires sequential treatment, including PEI, TACE or re-operation, and the intra-abdominal adhesions caused by traditional open surgery will affect the next step of treatment. Laparoscopic surgery forms fewer adhesions and can provide better conditions for postoperative treatment.
④ The immune function is less affected after laparoscopy, especially for cellular immunity with anti-tumor effect, which can be treated earlier with adjuvant therapy.
⑤ For patients with combined cirrhotic portal hypertension, the incidence of postoperative ascites and liver failure is significantly reduced.
2. Indications for laparoscopic hepatectomy for hepatocellular carcinoma
① Superficial hepatic occupying lesions in segments II, III, IVa, V and VI, especially marginal hepatic lesions located in the left outer lobe of the liver and the anterior segment of the right liver, are the best indications;
② The tumor size should not exceed 7cm-10cm, too large tumor will be difficult to operate, and too large liver section will easily cause uncontrollable hemorrhage;
③ No intrahepatic metastasis and other distant organ metastasis;
④ No portal vein cancer thrombosis;
⑤ No history of upper abdominal surgery;
⑥ Normal function of heart, lung, kidney and other important organs;
(7) The reserve status of liver function is an important factor in case selection, and a liver function Child grade of A or B is required.
3. Contraindications to laparoscopic hepatectomy for hepatocellular carcinoma
① Lesions located in segments I, VII and VIII are not easily exposed due to their special anatomical location and adjacent to the main large blood vessels of the liver, so reluctant surgery may lead to uncontrollable hemorrhage;
② lesions larger than 10 cm or located deep in the liver parenchyma or requiring resection of more than 3 liver segments at the same time;
(3) The lesions of hepatocellular carcinoma are more than 3, or the lesions are not large, but the requirement of no cancer infiltration at the cut edge cannot be guaranteed;
④ The lesion has invaded the inferior vena cava and the root of the hepatic vein, which is difficult to reveal microscopically and not easy to control bleeding;
⑤ Combined with intrahepatic metastasis, metastasis to other distant organs, portal vein cancer thrombus, metastasis to hilar lymph nodes or unclear tumor boundary;
⑥ Liver function grade Child C, or other important organ insufficiency;
(7) History of upper abdominal surgery with severe intra-abdominal adhesions, severe cirrhosis, and portal hypertension are relative contraindications.