Park Cheon-Soo, Hwang Shin, Ahn Chul-Soo, Kim Ki-Hun, Moon Deok-Bog, Ha Tae-Yong, Song Gi-Won, Jung Dong-Hwan, Park Gil-Chun, Park Hyung-Woo, Park Yo-Han, Kang Sung-Hwa, Jung Bo-Hyun, Lee Sung-Gyu
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Hepatobiliary Pancreat Surg. 2014 Feb;18(1):26-8. doi: 10.14701/kjhbps.2014.18.1.26. Epub 2014 Feb 24.
BACKGROUNDS/AIMS: After left-sided hepatectomy due to a living donor, the stomach can become adhered to the hepatic cut surface. An unwanted gastric stasis can occur. For prevention of such gastric adhesion and laparotomy-associated adhesive ileus, some anti-adhesive agents have been developed for intra-abdominal application. The purpose of this study is to evaluate the effect of an intraperitoneal anti-adhesive agent application compared with a historical control group.
The study group consisted of 220 consecutive living donors who donated a left-liver graft during the time period between January 2006 and December 2011. The anti-adhesive agent which was used was composed of sodium hyaluronate and sodium carboxymethyl cellulose. The historical control group which used no anti-adhesive agent included 220 consecutive left-liver donors during the time period between January 1998 and December 2004.
An overt gastric stasis which required fasting was observed in 5 subjects (2.3%) in the study group and in 7 subjects (3.2%) in the control group (p=0.77). An additional work-up to determine gastric stasis or prolonged ileus was performed in 17 (7.7%) and 22 (10%) donors, respectively (p=0.51). Only one donor in the control group underwent a laparotomy for an intestinal obstruction. No clinical factors such as patient age, sex, body mass index, remnant right liver proportion, shape of skin incision, and duration of surgery were significant risk factors of gastric stasis or prolonged ileus. No harmful side-effects of the anti-adhesive agent were identified.
As a result of this study, the application of an anti-adhesive agent could not be proved as to be effective for prevention of gastric stasis and postoperative ileus. A further randomized and controlled study will be required to demonstrate the real benefits of an anti-adhesive application in left-liver living donors.
背景/目的：在活体供肝行左半肝切除术后，胃可能会与肝脏断面粘连，进而可能出现不必要的胃潴留。为预防此类胃粘连及开腹相关的粘连性肠梗阻，已研发出一些用于腹腔内的抗粘连剂。本研究的目的是评估腹腔内应用抗粘连剂与历史对照组相比的效果。
研究组由2006年1月至2011年12月期间连续220例捐献左肝移植物的活体供者组成。所使用的抗粘连剂由透明质酸钠和羧甲基纤维素钠组成。未使用抗粘连剂的历史对照组包括1998年1月至2004年12月期间连续220例左肝供者。
研究组有5例受试者（2.3%）出现需要禁食的明显胃潴留，对照组有7例受试者（3.2%）出现（p = 0.77）。分别有17例（7.7%）和22例（10%）供者接受了进一步检查以确定胃潴留或肠梗阻延长（p = 0.51）。对照组仅1例供者因肠梗阻接受了剖腹手术。患者年龄、性别、体重指数、右肝残余比例、皮肤切口形状和手术时间等临床因素均不是胃潴留或肠梗阻延长的显著危险因素。未发现抗粘连剂有有害副作用。
本研究结果表明，抗粘连剂的应用在预防胃潴留和术后肠梗阻方面未被证明有效。需要进一步进行随机对照研究以证明抗粘连剂在左肝活体供者中的实际益处。
