Gaillard M, Tranchart H, Lainas P, Tzanis D, Franco D, Dagher I
Service de Chirurgie Digestive Minimale Invasive, Hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Sud, 15, rue Georges-Clémenceau, 91405 Orsay cedex, France.
Service de Chirurgie Digestive Minimale Invasive, Hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Sud, 15, rue Georges-Clémenceau, 91405 Orsay cedex, France.
J Visc Surg. 2015 Nov;152(5):292-6. doi: 10.1016/j.jviscsurg.2015.07.003. Epub 2015 Aug 28.
Over the last decade, laparoscopic hepatic surgery (LHS) has been increasingly performed throughout the world. Meanwhile, ambulatory surgery has been developed and implemented with the aims of improving patient satisfaction and reducing health care costs. The objective of this study was to report our preliminary experience with ambulatory minimally invasive LHS.
Between 1999 and 2014, 172 patients underwent LHS at our institution, including 151 liver resections and 21 fenestrations of hepatic cysts. The consecutive series of highly selected patients who underwent ambulatory LHS were included in this study.
Twenty patients underwent ambulatory LHS. Indications were liver cysts in 10 cases, liver angioma in 3 cases, focal nodular hyperplasia in 3 cases, and colorectal hepatic metastasis in 4 cases. The median operative time was 92 minutes (range: 50-240 minutes). The median blood loss was 35 mL (range: 20-150 mL). There were no postoperative complications or re-hospitalizations. All patients were hospitalized after surgery in our ambulatory surgery unit, and were discharged 5-7 hours after surgery. The median postoperative pain score at the time of discharge was 3 (visual analogue scale: 0-10; range: 0-4). The median quality-of-life score at the first postoperative visit was 8 (range: 6-10) and the median cosmetic satisfaction score was 8 (range: 7-10).
This series shows that, in selected patients, ambulatory LHS is feasible and safe for minor hepatic procedures.
在过去十年间，腹腔镜肝脏手术（LHS）在全球范围内的开展越来越多。与此同时，门诊手术得以发展并实施，旨在提高患者满意度并降低医疗成本。本研究的目的是报告我们在门诊微创LHS方面的初步经验。
1999年至2014年期间，我院有172例患者接受了LHS，包括151例肝切除术和21例肝囊肿开窗术。本研究纳入了连续一系列经过严格筛选并接受门诊LHS的患者。
20例患者接受了门诊LHS。手术指征包括肝囊肿10例、肝血管瘤3例、局灶性结节性增生3例以及结直肠癌肝转移4例。中位手术时间为92分钟（范围：50 - 240分钟）。中位失血量为35毫升（范围：20 - 150毫升）。无术后并发症或再次住院情况。所有患者术后均在我院门诊手术病房住院，并于术后5 - 7小时出院。出院时的中位术后疼痛评分为3分（视觉模拟评分：0 - 10分；范围：0 - 4分）。术后首次复诊时的中位生活质量评分为8分（范围：6 - 10分），中位美容满意度评分为8分（范围：7 - 10分）。
本系列研究表明，对于部分患者，门诊LHS在小型肝脏手术中是可行且安全的。
