MD Department HPB and Digestive Surgery, Ospedale Mauriziano "Umberto I", Largo Turati, 62-10128, Turin, Italy.
J Gastrointest Surg. 2012 Jul;16(7):1324-32. doi: 10.1007/s11605-012-1894-6. Epub 2012 May 9.
A prospective randomised controlled trial was designed to evaluate the advantages of routine application of the anterior approach during right hepatectomy.
The study was conducted between March 2005 and April 2009 in a tertiary hepatobiliary-pancreatic centre. Patients scheduled for right hepatectomy for primary or metastatic tumours, without infiltration of segment 1, inferior vena cava or main bile duct, were randomly assigned to right hepatectomy using either an anterior or a classic approach. The primary study endpoint was overall blood loss.
Sixty-six patients were randomly allocated to undergo right hepatectomy with an anterior (AA group n=33) or a classic approach (CA group n=33). Sixty-five patients were included in the analysis (33 in AA group and 32 in CA group). There was no significant difference in patient age, diagnosis, preoperative hepatic biochemistry and tumour size between the two groups. Overall blood loss (437 ml ± 664 in AA group vs.500 ml ± 532.3 in CA group; p=0.960) and bleeding during transection (p=0.973) were similar between two groups. Perioperative blood transfusion rates were 18% in the AA group and 9.3 % in the CA group (p=0.253). Time of parenchymal transsection was significantly longer in AA group (75.1 ± 26.6 min vs. 56.7 ± 17.5 min, p=0.01). There was no difference between both groups for postoperative prothrombin time, serum transaminase and total bilirubin levels. One patient died in each group (p=0.746). The two groups had similar morbidity rates.
Routine application of the anterior approach during right hepatectomy does not decrease intraoperative blood loss and morbidity rate.
本研究设计为前瞻性随机对照试验，旨在评估在右半肝切除术中常规应用前入路的优势。
该研究于 2005 年 3 月至 2009 年 4 月在一家三级肝胆胰中心进行。纳入标准为拟行右半肝切除术治疗原发性或转移性肿瘤，且不伴有肝段 1 浸润、下腔静脉或主胆管浸润的患者。将患者随机分为前入路组（AA 组，n=33）和经典入路组（CA 组，n=33）。主要研究终点为总失血量。
66 例患者随机分配至前入路组（AA 组，n=33）或经典入路组（CA 组，n=33）行右半肝切除术。65 例患者纳入分析（AA 组 33 例，CA 组 32 例）。两组患者的年龄、诊断、术前肝功能和肿瘤大小无显著差异。两组总失血量（AA 组 437ml±664ml 比 CA 组 500ml±532.3ml；p=0.960）和肝实质离断时出血量（p=0.973）无显著差异。AA 组围手术期输血率为 18%，CA 组为 9.3%（p=0.253）。AA 组肝实质离断时间显著长于 CA 组（75.1±26.6min 比 56.7±17.5min，p=0.01）。两组术后凝血酶原时间、血清转氨酶和总胆红素水平无差异。两组各有 1 例患者死亡（p=0.746）。两组并发症发生率相似。
在右半肝切除术中常规应用前入路并不能减少术中出血量和并发症发生率。
