肝S7,8の病変を有する大腸癌同時性肝転移における用手補助腹腔鏡下肝切除術

Hand-assisted laparoscopic hepatectomy for synchronous colorectal liver metastases located in segment 7 and/or 8

◆要旨：肝S7，8に病変を有する大腸癌同時性多発肝転移症例3例に対し，大腸切除術の開腹創をハンドポートとして利用した用手補助腹腔鏡下肝切除術を施行したので手術手技を中心に報告する．肝切除の平均所要時間は190分，肝切除中の平均出血量は43ml，全病変を露出することなく切除しえた．大腸癌原発巣に対して開腹手術を選択する場合，本術式は通常の開腹同時切除に比べ体壁破壊を小さくできるのみでなく，完全腹腔鏡下では難易度が高いとされる肝S7，8病変に対して低侵襲で安全な術式と考えられた．

Pure laparoscopic liver resection for segment 7 or 8 is reported to be technically challenging because of the limited visualization and the difficulty in controlling bleeding. We present operative procedures in three patients who had undergone hand-assisted laparoscopic partial liver resection for synchronous colorectal liver metastases located in segment 7 or 8. The lower midline incision for colorectal resection was used for the hand port. The mean operative time for hepatectomy and the amount of blood loss during hepatectomy were 190min and 43ml, respectively. All resectional margins were histologically negative. Hand-assisted laparoscopic hepatectomy is less invasive and safe in selected patients with synchronous colorectal liver metastases located in segment 7 or 8.