Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France; Department of Surgery, Nara Medical University, Nara, Japan.
Br J Surg. 2015 Feb;102(3):254-60. doi: 10.1002/bjs.9726. Epub 2014 Dec 17.
Although laparoscopic major hepatectomy (MH) is becoming increasingly common in several specialized centres, data regarding outcomes are limited. The aim of this study was to identify the risk factors for postoperative complications of purely laparoscopic MH at a single centre.
All patients who underwent purely laparoscopic MH between January 1998 and March 2014 at the authors' institution were enrolled. Demographic, clinicopathological and perioperative factors were collected prospectively, and data were analysed retrospectively. The dependent variables studied were the occurrence of overall and major complications (Dindo-Clavien grade III or above).
A total of 183 patients were enrolled. The types of MH included left-sided hepatectomy in 40 patients (21·9 per cent), right-sided hepatectomy in 135 (73·8 per cent) and central hepatectomy in eight (4·4 per cent). Median duration of surgery was 255 (range 100-540) min, and median blood loss was 280 (10-4500) ml. Complications occurred in 100 patients (54·6 per cent), and the 90-day all-cause mortality rate was 2·7 per cent. Liver-specific and general complications occurred in 62 (33·9 per cent) and 38 (20·8 per cent) patients respectively. Multivariable analysis identified one independent risk factor for global postoperative complications: intraoperative simultaneous radiofrequency ablation (RFA) (odds ratio (OR) 6·93, 95 per cent c.i. 1·49 to 32·14; P = 0·013). There were two independent risk factors for major complications: intraoperative blood transfusion (OR 2·50, 1·01 to 6·23; P = 0·049) and bilobar resection (OR 2·47, 1·00 to 6·06; P = 0·049).
Purely laparoscopic MH is feasible and safe. Simultaneous RFA and bilobar resection should probably be avoided.
虽然腹腔镜下肝切除术（MH）在一些专业中心越来越常见，但关于其结果的数据有限。本研究的目的是确定单中心行纯腹腔镜 MH 术后并发症的危险因素。
本研究纳入了 1998 年 1 月至 2014 年 3 月期间在作者所在机构接受纯腹腔镜 MH 的所有患者。前瞻性收集患者的人口统计学、临床病理学和围手术期资料，采用回顾性分析方法进行数据分析。研究的因变量为总并发症和主要并发症（Dindo-Clavien 分级 III 级或以上）的发生情况。
共纳入 183 例患者。MH 类型包括左半肝切除术 40 例（21.9%），右半肝切除术 135 例（73.8%）和中央肝切除术 8 例（4.4%）。手术时间中位数为 255（100-540）min，术中出血量中位数为 280（10-4500）ml。100 例患者（54.6%）发生并发症，90 天全因病死率为 2.7%。肝脏特异性并发症和一般并发症分别发生在 62 例（33.9%）和 38 例（20.8%）患者中。多变量分析确定了 1 个与总体术后并发症相关的独立危险因素：术中同时行射频消融术（RFA）（比值比（OR）6.93，95%可信区间（CI）为 1.49 至 32.14；P=0.013）。2 个独立的主要并发症危险因素为术中输血（OR 2.50，95%CI 为 1.01 至 6.23；P=0.049）和双叶切除（OR 2.47，95%CI 为 1.00 至 6.06；P=0.049）。
纯腹腔镜 MH 是可行和安全的。术中应尽量避免同时行 RFA 和双叶切除术。
