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纯腹腔镜活体供肝切除术:关注 55 例右半肝切除术供者。

Pure laparoscopic living donor hepatectomy: Focus on 55 donors undergoing right hepatectomy.

机构信息

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

Department of Surgery, Chonnam National University Medical School and Hospital, Gwangju, Korea.

出版信息

Am J Transplant. 2018 Feb;18(2):434-443. doi: 10.1111/ajt.14455. Epub 2017 Sep 7.

Abstract

Although laparoscopic donor hepatectomy is increasingly common, few centers with substantial experience have reported the results of pure laparoscopic donor right hepatectomy (PLDRH). Here, we report the experiences of 60 consecutive liver donors undergoing pure laparoscopic donor hepatectomy (PLDH), with most undergoing right hepatectomy. None of the 60 donors who underwent PLDH had intraoperative complications and none required transfusions, reoperation, or conversion to open hepatectomy. Forty-five donors who underwent PLDRH between November 2015 and December 2016 were compared with 42 who underwent conventional donor right hepatectomy (CDRH) between May 2013 and February 2014. The total operation time was longer (330.7 vs 280.0 minutes; P < .001) and the percentage with multiple bile duct openings was higher (53.3% vs 26.2%; P = .010) in the PLDRH group. However, the length of postoperative hospital stay (8.4 vs 8.2 days; P = .495) and rate of complications (11.9% vs 8.9%; P = .733) and re-hospitalizations (4.8% vs 4.4%; P = 1.000) were similar in both groups. PLDH, including PLDRH, is feasible when performed by a highly experienced surgeon and transplant team. Further evaluation, including long-term results, may support these preliminary findings of comparative outcomes for donors undergoing PLDRH and CDRH.

摘要

虽然腹腔镜供肝切除术越来越常见,但很少有经验丰富的中心报告纯腹腔镜供肝右叶切除术(PLDRH)的结果。在这里,我们报告了 60 例连续接受纯腹腔镜供肝切除术(PLDH)的肝供体的经验,其中大多数接受右肝叶切除术。在接受 PLDH 的 60 名供体中,没有发生术中并发症,也没有需要输血、再次手术或转为开腹肝切除术的情况。将 2015 年 11 月至 2016 年 12 月期间接受 PLDRH 的 45 名供体与 2013 年 5 月至 2014 年 2 月期间接受传统供体右肝叶切除术(CDRH)的 42 名供体进行比较。PLDRH 组的总手术时间更长(330.7 分钟 vs 280.0 分钟;P < 0.001),具有多个胆管开口的比例更高(53.3% vs 26.2%;P = 0.010)。然而,术后住院时间(8.4 天 vs 8.2 天;P = 0.495)、并发症发生率(11.9% vs 8.9%;P = 0.733)和再住院率(4.8% vs 4.4%;P = 1.000)在两组之间相似。当由经验丰富的外科医生和移植团队进行时,包括 PLDRH 在内的 PLDH 是可行的。进一步的评估,包括长期结果,可能会支持这些供体接受 PLDRH 和 CDRH 的初步比较结果。

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