Department of Surgery, Division of Transplantation, University of Louisville School of Medicine, Louisville, KY, USA.
J Am Coll Surg. 2011 Oct;213(4):501-7. doi: 10.1016/j.jamcollsurg.2011.04.032. Epub 2011 May 31.
Laparoscopic liver resection is a procedure in evolution. In the last decade it has evolved from a novel procedure to a standard part of the hepatic surgeon's armamentarium. Few data exist on the development of a laparoscopic resection program.
With IRB approval, a retrospective review of 300 consecutive laparoscopic liver resections was undertaken. To determine changing results and patterns of practice, the cohort was divided into 3 consecutive groups of 100 patients. Patient demographics, indications for operation, operative factors, and in-hospital outcomes were examined. Continuous variables were analyzed with the Kruskal-Wallis test; continuous variables were compared with Fisher's exact test. Univariate and multivariate analyses of major complications (≥grade 3) were performed using logistic regression.
Of the 300 patients, 173 (61.6%) were female, with a median age of 54 years. There were 133 (44.3%) major resections. The median number of segments resected increased (3 vs 2, p = 0.015), as did the percentage of repeat hepatectomies (13.0% vs 2.0%, p = 0.001). At the same time, median operative time decreased (2.25 vs 3.0 hours, p < 0.001).and estimated blood loss was similar (150 mL vs 150 mL, p = 0.635). Morbidity was similar (11% vs 14%, p = 0.300), as was mortality (1% vs 3%, p = 0.625).
Laparoscopic liver resection has evolved from a novel procedure to a vital technique in liver surgery. Our group has demonstrated the ability over time to perform more difficult resections with similar morbidity and decreased operative length.
腹腔镜肝切除术是一种不断发展的手术。在过去的十年中，它已从一种新的手术方法发展成为肝外科医生的标准武器之一。关于腹腔镜切除术计划的发展，几乎没有数据。
在 IRB 批准的情况下，对 300 例连续腹腔镜肝切除术进行了回顾性分析。为了确定不断变化的结果和手术模式，该队列分为 3 组，每组 100 例。检查了患者的人口统计学数据、手术适应证、手术因素和住院治疗结果。使用 Kruskal-Wallis 检验分析连续变量；使用 Fisher 确切检验比较连续变量。使用逻辑回归对主要并发症（≥3 级）进行单变量和多变量分析。
在 300 例患者中，有 173 例（61.6%）为女性，中位年龄为 54 岁。有 133 例（44.3%）为大切除术。切除的节段中位数增加（3 个 vs 2 个，p = 0.015），重复肝切除术的比例也增加（13.0% vs 2.0%，p = 0.001）。与此同时，中位手术时间缩短（2.25 小时 vs 3.0 小时，p < 0.001），估计失血量相似（150 毫升 vs 150 毫升，p = 0.635）。发病率相似（11% vs 14%，p = 0.300），死亡率也相似（1% vs 3%，p = 0.625）。
腹腔镜肝切除术已从一种新的手术方法发展成为肝外科的一项重要技术。我们的团队已经证明，随着时间的推移，我们有能力进行更困难的切除手术，同时保持相似的发病率和较短的手术时间。
