Avtor/Urednik		Sojar, Valentin; Stanisavljevič, Dragoje
Naslov		Laparoskopska kirurgija jeter: trenutne možnosti in perspektive
Prevedeni naslov		Laparoscopic liver surgery: current possibilities and future trends
Tip		članek
Vir		Endoskopska revija
Vol. in št.		Letnik 6, št. 15
Leto izdaje		2001
Obseg		str. 139-45
Jezik		slo
Abstrakt		Althrough in the past two decades laparoscopic surgical procedures have been introduced in the treatment of numerous surgical diseases, laparoskopic surgery of the liver remains limited to small series of resections and wedge excisions performed in specialised liver centres. Laparoscopy is a well-established treatment modality for the management of liver cysts and benign tumors. Diagnostic laparoscopy of malignant liver combined with laparoscopic ultrasound has been increasingly used for assessing the resectability of primary and secondary malignant diseases of the liver. Radio-frequency thermal ablation and cryosurgery via minimally invasive approach have been utilized to treat malignant hepatic tumours. At the Ljubljana Department of Abdominal Surgery, 25 patients underwent laparoscopic operations for liver disease between January 1997 and June 2001. Twenty-two patients had elective surgery, whilst in three the disease was discovered and treated during planned laparoscopic cholecystectomy. Anatomical resection was performed in three patients, resection of the left lateral section in two, and resection of segment 3 in one. Eight patients were operated on for giant disontogenetic cysts, measuring 6-13 cm, and one patient for polycystic liver disease. Total laparoscopic pericystectomy of hepatic hydatid cysts, 3-6 cm in size, was carried out in six patients. Diagnostic laparoscopy was performed in four patients. One patient had assessment of haemangioendothelioma of the liver before the planned liver transplantation, and one exploration and biopsy of diffuse liver adenomatosis. In two cases, laparoscopy was followed by laparotomy: in one patient it was done after laparoscopic assessment of a hydatid cyst in the first segment, and one after laparoscopic evaluation of the tumour in the left liver. (Abstract truncated at 2000 characters).
Izvleček		Laparoskopska kirurgija je v zadnjih dveh desetletjih razvoja postala način zdravljenja za vrsto kirurških bolezni. Kljub temu se laparoskopska kirurgija jeter omejuje na manjše serije resekcij in robnih ekscizij v centrih za hepatobiliarno kirurgijo. Laparoskopsko zdravljenje jetrnih cist in ablacija robnih benignih tumorjev jeter je sprejeta metoda zdravljenja. V zadnjem času se vedno bolj uveljavlja diagnostična laparoskopija z laparoskopsko ultrazvočno preiskavo za oceno resektabilnosti primarne ali sekundarne maligne bolezni v jetrih. Kot laparoskopska metoda se izvaja krio- in radiofrekvenčna ablacija malignih tumorjev jeter. Na Kliničnem oddelku za abdominalno kirurgijo v Ljubljani smo zaradi jeter od leta 1997 do sedaj laparoskopsko operirali 25 bolnikov. Pri 22 bolnikih je šlo za načrtovani poseg, pri treh je bila sprememba na jetrih odkrita slučajno ob laparoskopski holecistektomiji. Anatomsko resekcijo jeter smo napravili pri treh bolnikih. Leva lateralna sekcijonektomija je bila napravljena pri dveh bolnicah, pri enem bolniku pa resekcija segmenta 3. Operirali smo osem bolnikov zaradi večjih disontogenetskih cist (6-13 cm), eno bolnico zaradi policistične bolezni jeter. Napravili smo šest laparoskopskih totalnih pericistektomij ehinokoknih cist (3-6 cm). Pri dveh bolnikih je bila po laparoskopiji napravljena odprta operacija. Enkrat smo ocenjevali možnost laparoskopske odstranitve ehinokokne ciste v prvem segmentu in enkrat možnost resekcije levih jeter zaradi tumorja, ki se je kasneje histološko izkazal za malignega. Pri štirih bolnikih je bila napravljena diagnostična laparoskopija. Enkrat zaradi ocene razširjenosti hemangioendotelioma pred predvideno transplantacijo jeter, enkrat biopsija jeter in enkrat ocena možnosti laparoskopske odstranitve ehinokokbe ciste v prvem segmentu. (Izvleček prekinjen pri 2000 znakih).
Deskriptorji		LIVER NEOPLASMS LAPAROSCOPY HEPATECTOMY TREATMENT OUTCOME