Laparoscopic versus open left lateral hepatic sectionectomy: A comparative study
Laparoscopic versus open left lateral hepatic sectionectomy: A comparative study
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DOI：
10.1016/j.ejso.2008.01.018
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发表时间：
2008-12-01
期刊：
影响因子：
3.8
通讯作者：
Pearce, N. W.
中科院分区：
文献类型：
--
作者：
Abu Hilal, M.;McPhail, M. J. W.;Pearce, N. W.
背景：腹腔镜肝脏手术一直难以普及。大容量肝中心已确定左外侧切除术(LLS)是一种有可能转变为主要的腹腔镜手术的手术，外科医生可以安全地获得熟练的手术技能。方法：44例患者在南安普顿综合医院接受了腹腔镜(LLLS)或开腹(OLLS)左外侧切除术(节段II/III)。结果：OLLS组和LLS组在年龄、性别和肿瘤类型方面是匹配的。LLLS组中位手术时间为180(40~340)分钟，OLLS组为155(110~330)分钟(P=0.885)，术中出血量LLLS组为80(25~800)m l，大于470(100~3000)m l，P=0.002。与OLLS组(7(3-12)天；p<；0.001)相比，LLLS组的术后停留时间更短(3.5d(1-6)天)。两组手术切缘无差异(11(1.5-30)mm对12(4-40)mm，p=1)，并发症发生率也无差异(13%对25%，p=0.541)。在90天时，LLLS组没有中转开放，两组都没有死亡。术后中位手术时间从240(70~340)min降至120(40~120)min，p=0.005，中位住院天数从4.5d(2~6)d降至2(1~4)d，p=0.001。结论：LLLS是一种可行的手术方式，术中出血量明显减少，住院时间短，不影响手术成功率和并发症。在腹腔镜肝脏手术中探索这一新途径需要更大规模的前瞻性研究。(C)2008爱思唯尔有限公司。保留所有权利。
Background: Laparoscopic liver surgery has been difficult to popularize. High volume liver centres have identified left lateral sectionectomy (LLS) as a procedure with potential for transformation into a primarily laparoscopic procedure where surgeons can safely gain proficiency.Methods: Forty-four patients underwent either laparoscopic (LLLS) or open (OLLS) left lateral sectionectomy (of segments II/III) for focal lesions at Southampton General Hospital.Results: OLLS and LLLS groups were matched for age, sex and tumour types resected. Median operative time in the LLLS group was 180 (40-340) min and 155 (110-330) min in the OLLS group (p = 0.885) with median intra-operative blood loss in the LLLS group 80 (25-800) ml versus a larger 470 (100-3000) ml; p=0.002 for patients receiving OLLS. Post-operative stay was also shorter in the LLLS group (3.5 (1-6) days) compared to the OLLS group (7 (3-12) days; p < 0.001). Resection margin was not different in the two groups (11 (1.5-30) mm (LLLS) versus 12 (4-40) mm (OLLS); p = 1) and neither was the complication rate (13% for LLLS versus 25% for OLLS; p = 0.541). There were no conversions to open in the LLLS group and no deaths in either group at 90 days. Between the first and second 12 LLLS the median operative time fell from 240 (70-340) min to 120 (40-120) min; p = 0.005 as well as median post-operative hospital stay from 4.5 (2-6) days to 2 (1-4) days, p = 0.001.Conclusion: LLLS is a viable alternative to OLLS with potential improvements in intra-operative blood loss and shorter hospital stay without adversely affecting successful resection or complication rates. Larger prospective studies are required to explore this new avenue in laparoscopic liver surgery. (c) 2008 Elsevier Ltd. All rights reserved.