腹腔镜肝左叶解剖性肝段切除的手术方式与围手术期结局:文献病例汇总分析OA

Background and Aims:Laparoscopic anatomical hepatectomy has been increasingly applied to localized hepatic lesions;however,reports on anatomical segmentectomy or combined subsegmentectomy of the left hepatic lobe remain limited.Surgical access,identification of intersegmental planes,and preservation of major vascular structures remain technically challenging.This study aimed to summarize published cases of laparoscopic anatomical segmentectomy and/or combined subsegmentectomy of the left hepatic lobe and to analyze surgical procedures,operative approaches,intraoperative localization techniques,and perioperative outcomes,thereby providing a reference for standardized application of these procedures. Methods:The China National Knowledge Infrastructure,Wanfang Data,VIP,and Chinese Biomedical Literature databases,as well as PubMed,OVID,Embase,and Cochrane Library,were searched for relevant studies of laparoscopic anatomical segmentectomy and/or combined subsegmentectomy of the left hepatic lobe.Two investigators independently screened the literature and extracted data on study characteristics,surgical procedures,operative approaches,anatomical localization techniques,and perioperative outcomes.Descriptive analysis was performed to summarize the available evidence. Results:Ten studies involving 60 patients were included,with cases mainly reported from East Asia,including 4 from the Republic of Korea,51 from Japan,and 5 from China.Among the 56 patients with available sex information,41 were male and 15 were female.Patient age ranged from 22 to 82 years.Hepatocellular carcinoma was the predominant pathological diagnosis(50 cases).Lesions were mainly located in Couinaud segments S2 and S3,with some involving S4a,S4b,and S1/4;the reported maximum tumor diameter ranged from 0.9 to 6.0 cm.Surgical procedures mainly consisted of isolated segmentectomy or combined segmentectomy.The Glissonean approach was most frequently used,while cranial access,the round ligament approach,left lateral section flip-up technique,and parenchyma-first approach were also adopted according to lesion location and anatomical characteristics.Intersegmental boundaries were mainly identified using ischemic demarcation and ICG fluorescence,with intraoperative ultrasonography and three-dimensional reconstruction used in some cases.Operative time ranged from 115 to 464 min,mostly between 210 and 290 min,while blood loss ranged from 0 to 3 150 mL and was below 300 mL in most cases.Postoperative complications were generally uncommon and included Clavien-Dindo Classification grade I-Ⅱ complications,deep venous thrombosis with pulmonary embolism,and postoperative liver cut-surface fluid collection.All reported complications improved after appropriate management.Postoperative hospital stay ranged from 4 to 30 d. Conclusion:Available evidence suggests that laparoscopic anatomical segmentectomy and/or combined subsegmentectomy of the left hepatic lobe is feasible in selected patients.The Glissonean approach combined with ICG fluorescence,intraoperative ultrasonography,and three-dimensional reconstruction may facilitate accurate identification of segmental boundaries and precise resection.However,the current evidence is mainly derived from small case series with substantial heterogeneity.Variations in hepatic pedicles,exposure of the hepatic veins,and control of intersegmental planes remain major technical challenges.Further multicenter studies with larger sample sizes and long-term follow-up are warranted to evaluate the efficacy and safety of these procedures.