Dagher Ibrahim, Di Giuro Giuseppe, Dubrez Julien, Lainas Panagiotis, Smadja Claude, Franco Dominique
Department of General Surgery, Antoine Béclère Hospital, Clamart, France.
Am J Surg. 2009 Aug;198(2):173-7. doi: 10.1016/j.amjsurg.2008.09.015. Epub 2009 Mar 6.
The safety of laparoscopic major liver resections is still uncertain. The aim of this study was to compare our results for laparoscopic right hepatectomy (LRH) with those for open right hepatectomy (ORH).
Patients undergoing LRH were compared with retrospectively selected patients from our ORH database. The 2 groups were well matched for sex, age, American Society of Anesthesiologists score, body mass index, liver disease, and tumor size. Surgical and postsurgical outcomes were compared.
Seventy-two patients were analyzed: 22 in the LRH group and 50 in the ORH group. Operating time was similar. Blood loss was significantly less in laparoscopic resections (P = .038). Specific morbidity rates were not different, general morbidity was lower after laparoscopy (P = .04), and the severity of postsurgical complications was not different. Mean hospital stay was significantly shorter after laparoscopy (P = .009).
Laparoscopy improved surgical and postsurgical outcomes for ORH in selected patients. This is the first comparative study to demonstrate an advantage of laparoscopy for a major liver resection. Prospective randomized studies with a greater number of cases are needed to confirm the role of laparoscopy in major liver resections.
腹腔镜下大型肝切除术的安全性仍不确定。本研究的目的是比较我们腹腔镜右半肝切除术（LRH）与开腹右半肝切除术（ORH）的结果。
将接受LRH的患者与从我们的ORH数据库中回顾性选择的患者进行比较。两组在性别、年龄、美国麻醉医师协会评分、体重指数、肝脏疾病和肿瘤大小方面匹配良好。比较手术及术后结果。
分析了72例患者：LRH组22例，ORH组50例。手术时间相似。腹腔镜切除术的失血量明显较少（P = 0.038）。特定发病率无差异，腹腔镜术后总体发病率较低（P = 0.04），术后并发症的严重程度无差异。腹腔镜术后平均住院时间明显缩短（P = 0.009）。
腹腔镜手术改善了特定患者ORH的手术及术后结果。这是第一项证明腹腔镜在大型肝切除术中具有优势的比较研究。需要进行更多病例的前瞻性随机研究来证实腹腔镜在大型肝切除术中的作用。
