One Hundred Fifteen Cases of Pure Laparoscopic Living Donor Right Hepatectomy at a Single Center
One Hundred Fifteen Cases of Pure Laparoscopic Living Donor Right Hepatectomy at a Single Center
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DOI：
10.1097/tp.0000000000002229
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发表时间：
2018-11-01
期刊：
影响因子：
6.2
通讯作者：
Yi, Nam-Joon
中科院分区：
文献类型：
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作者：
Lee, Kwang-Woong;Hong, Suk Kyun;Yi, Nam-Joon
背景纯腹腔镜供肝切除术越来越多地被采用。然而，很少有中心执行纯腹腔镜供体右肝切除术（PLDRH），因为它需要高水平的手术技巧。报告PLDRH的初步结果的研究可能会促使该技术的进一步实施，并有助于减少其他移植中心的初始学习曲线。本研究报告了PLDRH在一个具有丰富成人活体肝移植经验的中心的表现。方法回顾性分析2015年11月至2017年6月期间接受PLDRH的115例供体（和受体）的资料。进行亚组分析以比较初始（2015年11月至2016年10月）和最近（2016年11月至2017年6月）期间的结果。结果在初始阶段，3例（2.6%）供者出现Clavien-Dindo评分大于III级的并发症。相比之下，在最近一段时间内，没有捐赠者出现并发症。手术时间（293.6分钟vs 344.4分钟，P < 0.001）和住院时间（7.3天vs 8.3天，P = 0.002）较近期明显缩短。血红蛋白（Hb）%计算为Hb% =[（术前Hb -术后Hb）/术前Hb] × 100 (14.9% vs 17.5%, P = 0.042)，天冬氨酸转氨酶（AST）%计算为AST% = [(AST峰值-术前AST)/术前AST] × 100 (1048.9% vs 1316.6%, P = 0.009)，近期均显著降低。结论单纯腹腔镜右肝切除术在有经验的成人活体肝移植中心进行是可行且安全的。1年内约60例pldrh的表现足以使程序标准化。
Background The pure laparoscopic approach to donor hepatectomy is being taken more often. However, few centers perform pure laparoscopic donor right hepatectomy (PLDRH) because it requires a high level of surgical skill. Studies reporting initial outcomes of PLDRH may prompt further implementation of the technique and help reduce initial learning curves at other transplant centers. This study reports performance of PLDRH at a single center with extensive experience of adult living donor liver transplantation.Methods Data from 115 donors (and recipients) who underwent PLDRH between November 2015 and June 2017 were analyzed retrospectively. Subgroup analysis was performed to compare outcomes between the initial (November 2015 to October 2016) and more recent (November 2016 to June 2017) periods.Results During the initial period, 3 (2.6%) donors experienced complications greater than grade III on the Clavien-Dindo scale. By contrast, no donors developed complications during the recent period. The operative time (293.6 minutes vs 344.4 minutes; P < 0.001) and hospital stay (7.3 days vs 8.3 days; P = 0.002) were significantly shorter during the more recent period. Also, hemoglobin (Hb)%, calculated as Hb% = [(preoperative Hb - postoperative Hb)/preoperative Hb] x 100 (14.9% vs 17.5%; P = 0.042), and aspartate aminotransferase (AST)%, calculated as AST% = [(peak AST - preoperative AST)/preoperative AST] x 100 (1048.9% vs 1316.6%; P = 0.009), were significantly lower during the recent period.Conclusions Pure laparoscopic donor right hepatectomy is both feasible and safe when performed at a center experienced in adult living donor liver transplantation. Performance of about 60 PLDRHs over 1 year is sufficient to standardize the procedure.