Coelho Fabricio Ferreira, Kruger Jaime Arthur Pirola, Jeismann Vagner Birk, Fonseca Gilton Marques, Makdissi Fábio Ferrari, Ferreira Leandro Augusto, D'Albuquerque Luiz Augusto Carneiro, Cecconello Ivan, Herman Paulo
1 Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School , São Paulo, Brazil .
2 Digestive Surgery Division, Department of Surgery, Cancer Institute of the State of São Paulo (ICESP) , São Paulo, Brazil .
J Laparoendosc Adv Surg Tech A. 2017 Dec;27(12):1236-1244. doi: 10.1089/lap.2017.0074. Epub 2017 May 12.
Hybrid liver resection is considered a modality of minimally invasive surgery; however, there are doubts regarding loss of benefits of laparoscopy due to the use of an auxiliary incision. We compared perioperative results of patients undergoing hybrid × open and hybrid × pure laparoscopic resections.
Consecutive patients undergoing liver resection between June 2008 and January 2016 were studied. Study groups were compared after propensity score matching (PSM).
Six hundred forty-four resections were included in the comparative analysis: 470 open, 120 pure laparoscopic, and 54 hybrids. After PSM, 54 patients were included in each group. Hybrid × open: hybrid technique had shorter operative time (319.5 ± 108.6 × 376.2 ± 155.8 minutes, P = .033), shorter hospital stay (6.0 ± 2.7 × 8.1 ± 5.6 days, P = .001), and lower morbidity (18.5% × 40.7%, P = .003). Hybrid × pure laparoscopic: hybrid group had lower conversion rate (0% × 13%, P = .013). There was no difference regarding estimated blood loss, transfusion rate, hospital stay, complications, or mortality.
Hybrid resection has better perioperative results than the open approach and is similar to pure laparoscopy. The hybrid technique should be considered a minimally invasive approach.
杂交肝切除术被认为是一种微创手术方式；然而，由于使用辅助切口，对于腹腔镜手术优势的丧失存在疑问。我们比较了接受杂交×开放和杂交×纯腹腔镜切除术患者的围手术期结果。
对2008年6月至2016年1月期间连续接受肝切除术的患者进行研究。在倾向评分匹配（PSM）后对研究组进行比较。
644例切除术纳入比较分析：470例开放手术，120例纯腹腔镜手术，54例杂交手术。PSM后，每组纳入54例患者。杂交×开放：杂交技术手术时间更短（319.5±108.6×376.2±155.8分钟，P = 0.033），住院时间更短（6.0±2.7×8.1±5.6天，P = 0.001），发病率更低（18.5%×40.7%，P = 0.003）。杂交×纯腹腔镜：杂交组转化率更低（0%×13%，P = 0.013）。估计失血量、输血率、住院时间、并发症或死亡率方面无差异。
杂交切除术围手术期结果优于开放手术方式，与纯腹腔镜手术相似。杂交技术应被视为一种微创手术方式。
