Kim Seong Hoon, Lee Seung Duk, Kim Young Kyu, Park Sang-Jae
Center for Liver Cancer, National Cancer Center, 111 Jungbalsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Korea.
Hepatobiliary Pancreat Dis Int. 2017 Feb;16(1):33-38. doi: 10.1016/s1499-3872(16)60146-7.
Few studies have evaluated the impact of previous abdominal surgery (PAS) on living donor right hepatectomy (LDRH). The aim of this study was to investigate the outcomes of liver transplantation using right lobe grafts of living donors with PAS.
Data were reviewed from LDRH patients at the authors' institution between March 2008 and November 2014. LDRH patients with PAS were divided into two groups according to upper PAS (group 1) or lower PAS (group 2), and they were compared to those without PAS (group 3) who were matched 1:1 based on age, gender, and body mass index. Perioperative data, complications by the Clavien classification, and the outcomes with more than 14 months follow-up were compared.
Twenty-three (4.9%) of a total of 471 LDRH donors had PAS. Eleven donors were assigned to group 1, 12 to group 2, and 23 to group 3. Intraperitoneal adhesions were found in 20 (87.0%) of 23 donors with PAS, of whom 5 (21.7%) had adhesiolysis-related injuries that happened more commonly in group 1 than in group 2 (P=0.025). LDRH was successfully completed under upper midline laparotomy in all donors. No donors received perioperative blood transfusion. The peak postoperative AST, ALT, INR, and total bilirubin levels made no difference between the three groups. Compared with group 3, groups 1 and 2 had a longer operative time (P=0.012) and a higher grade I complication rate (P=0.047). All donors recovered fully to their routine activities. The 23 recipients of grafts from donors with PAS showed good liver function with 1-year graft and patient survivals of 100%.
A history of PAS is not a contraindication to LDRH in the current era of advanced surgical techniques.
很少有研究评估既往腹部手术（PAS）对活体供体右半肝切除术（LDRH）的影响。本研究的目的是调查使用有PAS的活体供体右叶移植物进行肝移植的结果。
回顾了2008年3月至2014年11月期间作者所在机构的LDRH患者的数据。有PAS的LDRH患者根据上腹部PAS（第1组）或下腹部PAS（第2组）分为两组，并与无PAS的患者（第3组）进行比较，第3组根据年龄、性别和体重指数进行1:1匹配。比较围手术期数据、根据Clavien分类的并发症以及随访超过14个月的结果。
471例LDRH供体中共有23例（4.9%）有PAS。11例供体被分配到第1组，12例到第2组，23例到第3组。23例有PAS的供体中有20例（87.0%）发现腹腔粘连，其中5例（21.7%）发生了与粘连松解相关的损伤，在第1组比第2组更常见（P=0.025）。所有供体均通过上腹部正中剖腹术成功完成LDRH。没有供体接受围手术期输血。三组术后AST、ALT、INR和总胆红素峰值水平无差异。与第3组相比，第1组和第2组手术时间更长（P=0.012），I级并发症发生率更高（P=0.047）。所有供体均完全恢复日常活动。23例接受有PAS供体移植物的受者肝功能良好，1年移植物和患者生存率均为100%。
在当前先进手术技术时代，PAS史并非LDRH的禁忌证。
