Zheng Baijun,Yu Hui,Li Peng,et al.Technical improvements and therapeutic efficacies of laparoscopic liver resection in children[J].Journal of Clinical Pediatric Surgery,,21():622-626.[doi:10.3760/cma.j.cn101785-202205026-005]
Technical improvements and therapeutic efficacies of laparoscopic liver resection in children
- Abstract:
- Objective To introduce the technical improvements of laparoscopic liver resection (LLR) in children and evaluate its therapeutic efficacies.Methods Clinical data were retrospectively reviewed for 17 children with hepatic masses undergoing LLR from June 2019 to March 2022.There were 8 boys and 9 girls with a median operative age of 21(2-44) months.Patient demographics, perioperative imaging studies, surgical procedures and parameters, postoperative serum biochemical tests, postoperative complications and follow-up data were recorded.The major surgical improvements included preoperative virtual surgical planning based upon three-dimensional reconstruction and routine application of indocyanine green (ICG) navigation during liver parenchyma division and resecting first/econd-class ducts outside Glissonean pedicle or lowering central venous pressure during parenchyma division in selected cases. Results There were benign lesions (n=3) and hepatoblastoma (HB, n=14).The longest average diameter of hepatic mass was 6.2(3.2-14.4) cm.Non-anatomical liver resection was performed for S7 (n=1) and S4a(n=1).Among anatomical liver resections, there were left lateral sectionectomy (n=1), left hepatectomy (n=7), right hepatectomy (n=3) and right posterior sectionectomy (n=3).An associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) was performed in a 3-year-old girl with hepatic mesenchymal hamartoma.The median operative duration was 234.4(70-360) min and the median estimated volume of blood loss 60.7(20-300) ml.One child was converted into laparotomy.The girl undergoing ALPPS developed bile leakage postoperatively and it was cured by drainage.There were no other perioperative complications and all HB cases underwent R0 resection.The average postoperative recovery time of liver function was 7(5-12) days.A child of HB and pulmonary metastasis developed pulmonary recurrence at Month 14 post-operation and there was no other recurrence during follow-ups. Conclusion Surgical complications of LLR in children may be minimized through strictly complying with surgical indications, mastering spatial anatomy of hepatic mass by preoperative three-dimensional reconstruction, selecting a proper surgical approach and routinely applying ICG navigation.
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Memo
收稿日期:2022-05-09。
基金项目:国家自然科学基金（82071692，82170531）
通讯作者:高亚,Email:ygao@mail.xjtu.edu.cn