The exploration of the application of laparoscopic precise local hepatectomy guided by the positioning needle

doi:10.3877/cma.j.issn.1674-6899.2024.02.012

Abstract

Abstract:

Objective

To Explore the safety and effective of laparoscopic liver resection guided by the positioning needle for deep hepatic tumors.

Methods

We retrospectively reviewed 6 patients with HCC who underwent laparoscopic hepatectomy (LH) guided by the positioning needle from Jun. 2021 to Dec. 2022. The safety of needle positioning and accuracy of target-territory resection together with R0 resection rate were analyzed.

Results

1 patient with 2 lesions simultaneously were localized by ultrasound, while the remaining 5 cases were all CT guided localization. All lesions were accurately located and anchored reliably, without loosening or displacement.In 6 patients, All 7 lesions achieved R0 resection (100%). The hemorrhage caused by localization operation was 5 to 30 (13.2±9.8) ml. The margin-negative was 0.9 to 2.5 (1.9±0.5) cm.There were no perioperative mortality and reoperation cases.

Conclusions

The pilot study shows that positioning needle is effective and safe, helpful to precise positioning and localization guidance. Under specific conditions, it may be a beneficial supplement to intraoperative ultrasound and ICG fluorescence-guided LH surgery.

Key words: Needles, Laparoscopic hepatectomy, Hepatocellular carcinoma, Tumor localization, Radiography

Zheng Chen, Qingwang Ye, Dongbo Zhao, Xin Shi, Jianqiang Wu, Decai Yu. The exploration of the application of laparoscopic precise local hepatectomy guided by the positioning needle[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(02): 125-128.

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URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2024.02.012

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2024/V17/I02/125

Figures/Tables 5

References 12

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患者	性别	年龄	HBsAg检测	Child-pugh评分	ICG R5%	病灶数目(个)	病灶大小(cm)	距离肝表面距离(cm)	影像学脉管侵犯	AFP值(参考值0～10 ng/ml)
1	男	54	阳性	7	13.4	2	1.1&1.6	0.5/0.9	无	8.6
2	男	55	阳性	5	6.8	1	3.1	1.9	无	652.7
3	男	60	阳性	7	16.5	1	2.9	1.0	无	9.3
4	男	63	阳性	7	19.8	1	3.2	2.1	无	1.9
5	男	64	阳性	5	7.0	1	4.7	2.7	无	0.6
6	男	78	阳性	5	9.1	1	3.9	2.5	无	2.3

患者	性别	年龄	HBsAg检测	Child-pugh评分	ICG R5%	病灶数目(个)	病灶大小(cm)	距离肝表面距离(cm)	影像学脉管侵犯	AFP值(参考值0～10 ng/ml)
1	男	54	阳性	7	13.4	2	1.1&1.6	0.5/0.9	无	8.6
2	男	55	阳性	5	6.8	1	3.1	1.9	无	652.7
3	男	60	阳性	7	16.5	1	2.9	1.0	无	9.3
4	男	63	阳性	7	19.8	1	3.2	2.1	无	1.9
5	男	64	阳性	5	7.0	1	4.7	2.7	无	0.6
6	男	78	阳性	5	9.1	1	3.9	2.5	无	2.3

参数	病例1	病例2	病例3	病例4	病例5	病例6	统计分析(±s)
定位引导方式	超声	CT	CT	CT	CT	CT
定位引起失血(ml)	5	10	6	8	20	30	13.2±9.8
手术失血(ml)	80	50	60	60	250	100	100±75.6
手术时间(min)	138	102	121	150	183	149	140.5±27.7
切缘(cm)	0.9/1.6	1.9	2.1	2.3	2.0	2.5	1.9±0.5
荧光腔镜	否	是(荧光难以定位病灶)	否	否	否	否
术后AFP值(ng/ml)	4.9	2.5	6.8	3.0	1.4	2.5	3.5±1.9
住院时间(d)	7	10	10	12	10	12	10.2±1.8
术后2个月评估R0切除	R0	R0	R0	R0	R0	R0	100%

参数	病例1	病例2	病例3	病例4	病例5	病例6	统计分析(±s)
定位引导方式	超声	CT	CT	CT	CT	CT
定位引起失血(ml)	5	10	6	8	20	30	13.2±9.8
手术失血(ml)	80	50	60	60	250	100	100±75.6
手术时间(min)	138	102	121	150	183	149	140.5±27.7
切缘(cm)	0.9/1.6	1.9	2.1	2.3	2.0	2.5	1.9±0.5
荧光腔镜	否	是(荧光难以定位病灶)	否	否	否	否
术后AFP值(ng/ml)	4.9	2.5	6.8	3.0	1.4	2.5	3.5±1.9
住院时间(d)	7	10	10	12	10	12	10.2±1.8
术后2个月评估R0切除	R0	R0	R0	R0	R0	R0	100%

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