Ban Daisuke, Tanabe Minoru, Ito Hiromitsu, Otsuka Yuichiro, Nitta Hiroyuki, Abe Yuta, Hasegawa Yasushi, Katagiri Toshio, Takagi Chisato, Itano Osamu, Kaneko Hironori, Wakabayashi Go
Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
J Hepatobiliary Pancreat Sci. 2014 Oct;21(10):745-53. doi: 10.1002/jhbp.166.
Early on, laparoscopic liver resection (LLR) was limited to partial resection, but major LLR is no longer rare. A difficulty scoring system is required to guide surgeons in advancing from simple to highly technical laparoscopic resections. Subjects were 90 patients who had undergone pure LLR at three medical institutions (30 patients/institution) from January 2011 to April 2014. Surgical difficulty was assessed by the operator using an index of 1-10 with the following divisions: 1-3 low difficulty, 4-6 intermediate difficulty, and 7-10 high difficulty. Weighted kappa statistic was used to calculate the concordance between the operators' and reviewers' (expert surgeon) difficulty index. Inter-rater agreement (weighted kappa statistic) between the operators' and reviewers' assessments was 0.89 with the three-level difficulty index and 0.80 with the 10-level difficulty index. A 10-level difficulty index by linear modeling based on clinical information revealed a weighted kappa statistic of 0.72 and that scored by the extent of liver resection, tumor location, tumor size, liver function, and tumor proximity to major vessels revealed a weighted kappa statistic of 0.68. We proposed a new scoring system to predict difficulty of various LLRs preoperatively. The calculated score well reflected difficulty.
早期，腹腔镜肝切除术（LLR）仅限于部分切除，但大型LLR已不再罕见。需要一个难度评分系统来指导外科医生从简单的腹腔镜切除手术向高难度的手术推进。研究对象为2011年1月至2014年4月在三家医疗机构（每家机构30例患者）接受单纯LLR的90例患者。手术难度由术者使用1 - 10分的指数进行评估，划分如下：1 - 3分为低难度，4 - 6分为中等难度，7 - 10分为高难度。采用加权kappa统计量计算术者与评审者（专家外科医生）难度指数之间的一致性。术者与评审者评估之间的组间一致性（加权kappa统计量）在三级难度指数下为0.89，在十级难度指数下为0.80。基于临床信息通过线性建模得出的十级难度指数的加权kappa统计量为0.72，根据肝切除范围、肿瘤位置、肿瘤大小、肝功能以及肿瘤与主要血管的接近程度评分得出的加权kappa统计量为0.68。我们提出了一种新的评分系统，用于术前预测各种LLR的难度。计算出的分数能很好地反映难度。
