Rowe Andrea J, Meneghetti Adam T, Schumacher P Andrew, Buczkowski Andrzej K, Scudamore Charles H, Panton O Neely M, Chung Stephen W
Department of Surgery, Diamond Health Care Centre, University of British Columbia, 2775 Laurel Street, 5th Floor, Vancouver, V5Z 1M9, BC, Canada.
Surg Endosc. 2009 Jun;23(6):1198-203. doi: 10.1007/s00464-009-0372-z. Epub 2009 Mar 5.
Over the past decade there has been an increasing trend toward minimally invasive liver surgery. Initially limited by technical challenges, advances in laparoscopic techniques have rendered this approach safe and feasible. However, as health care costs approach 50% of some provincial budgets, surgical innovation must be justifiable in costs and patient outcomes. With introduction of standardized postoperative liver resection guidelines to optimize patient hospital length of stay, the advantages of laparoscopic liver resection (LLR) compared with open liver resection (OLR) measured by perioperative outcomes and resource utilization are not well defined. It remains to be established whether LLR is superior to OLR by these measurements.
Eighteen LLRs performed at the Vancouver General Hospital from 2005 to 2007 were prospectively analyzed. These data were compared with an equivalent group of 12 consecutive OLRs undertaken immediately prior to the introduction of LLR. Outcomes were evaluated for differences in perioperative morbidity, hospital length of stay, and operative costs.
There were no differences between LLRs and OLRs in demographics, pathology, cirrhosis, tumour location or extent of resection. There were no deaths. LLRs had significantly decreased intraoperative blood loss (287 ml versus 473 ml, p = 0.03), postoperative complications (6% versus 42%, p = 0.03), and length of stay (4.3 versus 5.8 days, p = 0.01) compared with OLRs. There were no differences in operating time for LLRs compared to OLRs (135 min versus 138 min, respectively), total time in the operating theatre (214 min versus 224 min), or costs related to stapler/trocar devices (CA $1267 versus CA $1007).
LLR is associated with decreased morbidity and decreased resource utilization compared with OLR. Perioperative patient outcomes and cost-effectiveness justify LLR despite introduction of standardized postoperative liver resection guidelines and decreased length of stay for OLR.
在过去十年中，微创肝脏手术呈上升趋势。腹腔镜技术最初受技术挑战限制，如今其发展已使该方法安全可行。然而，随着医疗保健费用接近一些省级预算的50%，手术创新必须在成本和患者预后方面具有合理性。随着标准化术后肝切除指南的引入以优化患者住院时间，通过围手术期结果和资源利用来衡量，腹腔镜肝切除（LLR）与开放肝切除（OLR）相比的优势尚不明确。通过这些指标，LLR是否优于OLR仍有待确定。
对2005年至2007年在温哥华总医院进行的18例LLR进行前瞻性分析。将这些数据与在LLR引入之前立即进行的连续12例OLR的同等组进行比较。评估围手术期发病率、住院时间和手术成本的差异。
LLR和OLR在人口统计学、病理学、肝硬化、肿瘤位置或切除范围方面无差异。无死亡病例。与OLR相比，LLR术中出血量显著减少（287毫升对473毫升，p = 0.03），术后并发症减少（6%对42%，p = 0.03），住院时间缩短（4.3天对5.8天，p = 0.01）。LLR与OLR的手术时间（分别为135分钟对138分钟）、手术室总时间（214分钟对224分钟）或与吻合器/套管装置相关的成本（1267加元对1007加元）无差异。
与OLR相比，LLR与发病率降低和资源利用减少相关。尽管引入了标准化术后肝切除指南且OLR住院时间缩短，但围手术期患者结果和成本效益证明LLR是合理的。
