Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA.
Am J Surg. 2011 Sep;202(3):273-80. doi: 10.1016/j.amjsurg.2010.07.042.
Complex hepatobiliary surgical procedures for benign and malignant conditions are regularly performed at tertiary academic referral centers with excellent outcomes, but whether similar surgical outcomes are achievable in community hospitals is not well documented.
Eighty-four patients underwent complex hepatobiliary surgery between December 2004 and December 2008. Data were prospectively analyzed, including patient demographics, operative procedures, perioperative parameters, pathology, complications up to 30 days postoperatively, and long-term outcomes.
The most frequent procedures performed were isolated segmentectomy or segmentectomies (n = 41 [49%]). Major hepatic resections (n = 32 [38%]) included 25 lobectomies (30%) and 7 trisegmentectomies (8%). Nine patients (11%) had surgical complications, and the most common indications for surgery was metastatic carcinoma (n = 42 [50%]).
Complex hepatobiliary surgery can be performed safely at a community-based teaching hospital with excellent outcomes. In the ongoing debate centering on mandatory referral and centralization of complex surgical procedures, tertiary community hospitals with well-determined outcomes should be included.
复杂的肝胆外科手术可用于治疗良性和恶性疾病，在三级学术转诊中心进行时通常可取得良好的效果，但在社区医院是否也能达到类似的手术效果，相关记录并不充分。
2004 年 12 月至 2008 年 12 月期间，84 例患者接受了复杂肝胆手术。前瞻性分析了患者的人口统计学资料、手术过程、围手术期参数、病理学、术后 30 天内的并发症以及长期结果。
最常进行的手术是孤立性肝段切除术或肝段切除术（n = 41 [49%]）。 32 例（38%）患者进行了主要肝切除术，其中包括 25 例肝叶切除术（30%）和 7 例三叶切除术（8%）。9 例（11%）患者发生手术并发症，最常见的手术适应证是转移性癌（n = 42 [50%]）。
在以社区为基础的教学医院中，复杂肝胆手术可以安全进行，并可获得良好的效果。在目前围绕复杂手术程序的强制性转诊和集中化的争论中，应将具有明确结果的三级社区医院纳入其中。
