Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris Est University, APHP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France.
Department of Liver Transplantation and HPB Surgery, Pitié-Salpêtrière Hospital, Paris, France.
Surg Endosc. 2017 Oct;31(10):4136-4144. doi: 10.1007/s00464-017-5466-4. Epub 2017 Mar 9.
Patients with hepatocellular adenomas are, in selected cases, candidates for liver resection, which can be approached via laparoscopy or laparotomy. The present study aimed to investigate the effects of the surgical approach on the postoperative morbidities of both minor and major liver resections.
In this multi-institutional study, all patients who underwent open or laparoscopic hepatectomies for hepatocellular adenomas between 1989 and 2013 in 27 European centers were retrospectively reviewed. A multiple imputation model was constructed to manage missing variables. Comparisons of both the overall rate and the types of complications between open and laparoscopic hepatectomy were performed after propensity score adjustment (via the standardized mortality ratio weighting method) on the factors that influenced the choice of the surgical approach.
The laparoscopic approach was selected in 208 (38%) of the 533 included patients. There were 194 (93%) women. The median age was 38.9 years. After the application of multiple imputation, 208 patients who underwent laparoscopic operations were compared with 216 patients who underwent laparotomic operations. After adjustment, there were 20 (9.6%) major liver resections in the laparoscopy group and 17 (7.9%) in the open group. The conversion rate was 6.3%. The two surgical approaches exhibited similar postoperative morbidity rates and severities. Laparoscopic resection was associated with significantly less blood loss (93 vs. 196 ml, p < 0.001), a less frequent need for pedicle clamping (21 vs. 40%, p = 0.002), a reduced need for transfusion (8 vs. 24 red blood cells units, p < 0.001), and a shorter hospital stay (5 vs. 7 days, p < 0.001). The mortality was nil.
Laparoscopy can achieve short-term outcomes similar to those of open surgery for hepatocellular adenomas and has the additional benefits of a reduced blood loss, need for transfusion, and a shorter hospital stay.
在某些情况下，患有肝细胞腺瘤的患者适合接受肝切除术，这种手术可以通过腹腔镜或剖腹手术进行。本研究旨在探讨手术方法对小肝切除术和大肝切除术术后并发症的影响。
在这项多机构研究中，回顾了 1989 年至 2013 年间 27 个欧洲中心的 27 个欧洲中心的所有接受开放或腹腔镜肝切除术治疗肝细胞腺瘤的患者。采用多元插补模型来处理缺失变量。在对影响手术方法选择的因素进行倾向评分调整（通过标准化死亡率比加权法）后，比较了开放手术和腹腔镜手术的总体并发症发生率和并发症类型。
在纳入的 533 例患者中，有 208 例（38%）采用了腹腔镜方法。其中 194 例（93%）为女性，中位年龄为 38.9 岁。在应用多元插补后，将 208 例接受腹腔镜手术的患者与 216 例接受剖腹手术的患者进行了比较。调整后，腹腔镜组有 20 例（9.6%）为大肝切除术，开腹组有 17 例（7.9%）。中转率为 6.3%。两种手术方法的术后发病率和严重程度相似。腹腔镜切除与术中出血量明显减少（93 与 196ml，p<0.001）、肝蒂夹闭需求减少（21 与 40%，p=0.002）、输血需求减少（8 与 24 单位红细胞，p<0.001）和住院时间缩短（5 与 7 天，p<0.001）有关。死亡率为零。
腹腔镜手术可为肝细胞腺瘤患者带来与开放性手术相似的短期效果，且具有出血量减少、输血需求减少和住院时间缩短等额外益处。
