Pulmonary complications after laparoscopic liver resection
Pulmonary complications after laparoscopic liver resection
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DOI：
10.1007/s00464-020-07549-w
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发表时间：
2020-04-13
影响因子：
3.1
通讯作者：
Sho, Masayuki
中科院分区：
文献类型：
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作者：
Matsuo, Yasuko;Nomi, Takeo;Sho, Masayuki
背景虽然术后肺部并发症（PPC）是肝脏手术后常见的并发症之一，并且可以通过使用腹腔镜方法来避免，但很少有报道关注腹腔镜肝切除术（LLR）和开放性肝切除术（OLR）之间PPC的比较。本研究的目的是阐明LLR对PPC的影响。方法该研究纳入了2014年至2018年期间在我们机构接受肝切除术（不包括胆道重建）的307例患者。患者分为OLR和LLR组。采用倾向评分匹配法比较两组围手术期结局和PPC。在肝脏手术后第3天，所有患者都进行了胸部X线摄影，以确认胸腔积液的存在，包括需要胸腔穿刺术和肺炎的病例。结果307例患者中，OLR组172例，LLR组135例。倾向评分匹配后，每组65例患者。与匹配的OLR组相比，匹配的LLR组的术中失血量显著减少（P < 0.001）;术中输血率（P = 0.011）;总体PPC（P = 0.032）;和胸部X线检查证实胸腔积液的病例数（P = 0.048）、需要胸腔穿刺术的胸腔积液（P = 0.029）和肺炎（P = 0.012）。此外，匹配LLR组的术后住院时间显著短于匹配OLR组。结论与OLR相比，LLR可能是一种更好的避免PPC的手术入路。
Background Although postoperative pulmonary complications (PPCs) are one of the common complications after liver surgery and might be avoided with the use of a laparoscopic approach, few reports have focused on the comparison of PPCs between laparoscopic liver resection (LLR) and open liver resection (OLR). The aim of this study was to clarify the effect of LLR on PPCs. Methods The study included 307 patients who underwent liver resection, excluding biliary reconstruction, at our institution between 2014 and 2018. Patients were divided into the OLR and LLR groups. The perioperative outcomes and PPCs were compared between the two groups using propensity score matching. On day 3 after liver surgery, all patients had chest radiography to confirm the presence of pleural effusion, including cases that required thoracentesis, and pneumonia. Results Of the 307 patients, 172 and 135 patients were included in OLR and LLR groups, respectively. After propensity score matching, 65 patients were included in each group. Compared with the matched OLR group, the matched LLR group had significantly lower intraoperative blood loss (P < 0.001); rate of intraoperative blood transfusion (P = 0.011); overall PPCs (P = 0.032); and number of cases with chest radiography-confirmed pleural effusion (P = 0.048), pleural effusion requiring thoracentesis (P = 0.029), and pneumonia (P = 0.012). Moreover, postoperative hospital stay was significantly shorter in the matched LLR group than in the matched OLR group. Conclusions Compared with OLR, LLR might be a better surgical approach to avoid PPCs.