Kim Yuhree, Amini Neda, He Jin, Margonis Georgios A, Weiss Matthew, Wolfgang Christopher L, Makary Martin, Hirose Kenzo, Spolverato Gaya, Pawlik Timothy M
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
Surgery. 2015 Jun;157(6):1055-64. doi: 10.1016/j.surg.2015.01.015. Epub 2015 Mar 11.
The widespread use of diagnostic imaging has led to an increase in the incidence and diagnosis of benign liver tumors. The objective of this study was to define the overall use and temporal trends of operative procedures for benign liver tumors using a nationally representative cohort.
All patients who underwent liver surgery for benign liver tumors between 2000 and 2011 were identified from the Nationwide Inpatient Sample database. Trends in annual volume of liver procedures were analyzed using the average annual percent change (AAPC) assessed by joinpoint analysis.
There were 2,489 open (94.5%) and 144 (5.5%) minimally invasive surgical (MIS) procedures. Partial hepatectomy accounted for 43.8% of all cases (n = 1,153). Surgery for patients with benign liver tumors increased from 156 in 2000 to 272 in 2011 (AAPC, 5.8%; 95% CI, 3.2-8.6%). There was decline in the relative use of open operative procedures from 98.1% in 2000 to 92.3% in 2011 (AAPC, -0.4%; 95% CI, -0.7 to -0.1%). In contrast, the proportion of MIS procedures increased from 1.9% in 2000 to 7.7% in 2011 (AAPC, 7.4%; 95% CI, 1.9-13.3%). The median duration of stay among all patients was 5 days (interquartile range, 4-7; 5 days [open] vs 3 days [MIS]; P < .001). Inpatient mortality was 0.6% (n = 15 [open] vs n = 0 [MIS]; P = .43) and did not change during the study period (P > .05).
Overall volume of surgical management of benign liver tumors has increased substantially over the past decade. There has been a relative shift away from open procedures toward MIS procedures.
诊断性成像技术的广泛应用导致良性肝肿瘤的发病率和诊断率上升。本研究的目的是使用具有全国代表性的队列来确定良性肝肿瘤手术治疗的总体使用情况和时间趋势。
从全国住院患者样本数据库中识别出2000年至2011年间因良性肝肿瘤接受肝脏手术的所有患者。使用连接点分析评估的年均百分比变化（AAPC）分析肝脏手术年手术量的趋势。
共有2489例开放手术（94.5%）和144例（5.5%）微创手术（MIS）。肝部分切除术占所有病例的43.8%（n = 1153）。良性肝肿瘤患者的手术例数从2000年的156例增加到2011年的272例（AAPC，5.8%；95%CI，3.2 - 8.6%）。开放手术的相对使用率从2000年的98.1%下降到2011年的92.3%（AAPC， - 0.4%；95%CI， - 0.7至 - 0.1%）。相比之下，MIS手术的比例从2000年的1.9%增加到2011年的7.7%（AAPC，7.4%；95%CI，1.9 - 13.3%）。所有患者住院时间的中位数为5天（四分位间距，4 - 7；开放手术为5天，MIS手术为3天；P < 0.001）。住院死亡率为0.6%（开放手术n = 15例，MIS手术n = 0例；P = 0.43），且在研究期间未发生变化（P > 0.05）。
在过去十年中，良性肝肿瘤手术治疗的总体例数大幅增加。手术方式已从开放手术相对转向MIS手术。
