Fujikawa Takahisa, Kawamoto Hiroshi, Kawamura Yuichiro, Emoto Norio, Sakamoto Yusuke, Tanaka Akira
Takahisa Fujikawa, Hiroshi Kawamoto, Yuichiro Kawamura, Norio Emoto, Yusuke Sakamoto, Akira Tanaka, Department of Surgery, Kokura Memorial Hospital, Fukuoka 802-8555, Japan.
World J Gastrointest Endosc. 2017 Aug 16;9(8):396-404. doi: 10.4253/wjge.v9.i8.396.
To assess the impact of laparoscopic liver resection (LLR) on surgical blood loss (SBL), especially in patients with antithrombotics for thromboembolic risks.
Consecutive 258 patients receiving liver resection at our institution between 2010 and 2016 were retrospectively reviewed. Preoperative antithrombotic therapy (ATT; antiplatelets and/or anticoagulation) was regularly used in 100 patients (ATT group, 38.8%) whereas not used in 158 (non-ATT group, 61.2%). Our perioperative management of high thromboembolic risk patients included maintenance of preoperative aspirin monotherapy for patients with antiplatelet therapy and bridging heparin for patients with anticoagulation. In both ATT and non-ATT groups, outcome variables of patients undergoing LLR were compared with those of patients receiving open liver resection (OLR), and the independent risk factors for increased SBL were determined by multivariate analysis.
This series included 77 LLR and 181 OLR. There were 3 thromboembolic events (1.2%) in a whole cohort, whereas increased SBL (≥ 500 mL) and postoperative bleeding complications (BCs) occurred in 66 patients (25.6%) and 8 (3.1%), respectively. Both in the ATT and non-ATT groups, LLR was significantly related to reduced SBL and low incidence of BCs, although LLR was less performed as anatomical resection. Multivariate analysis showed that anatomical liver resection was the most significant risk factor for increased SBL [risk ratio (RR) = 6.54, < 0.001] in the whole cohort, and LLR also had the significant negative impact (RR = 1/10.0, < 0.001). The same effects of anatomical resection (RR = 15.77, < 0.001) and LLR (RR = 1/5.88, = 0.019) were observed when analyzing the patients in the ATT group.
LLR using the two-surgeon technique is feasible and safely performed even in the ATT-burdened patients with thromboembolic risks. Independent from the extent of liver resection, LLR is significantly associated with reduced SBL, both in the ATT and non-ATT groups.
评估腹腔镜肝切除术（LLR）对手术失血（SBL）的影响，尤其是在有血栓栓塞风险且接受抗栓治疗的患者中。
回顾性分析2010年至2016年在我院接受肝切除术的258例连续患者。100例患者（ATT组，38.8%）常规接受术前抗栓治疗（ATT；抗血小板和/或抗凝治疗），而158例患者（非ATT组，61.2%）未接受。我们对高血栓栓塞风险患者的围手术期管理包括对接受抗血小板治疗的患者维持术前阿司匹林单药治疗，以及对接受抗凝治疗的患者采用桥接肝素治疗。在ATT组和非ATT组中，将接受LLR患者的结局变量与接受开腹肝切除术（OLR）患者的结局变量进行比较，并通过多因素分析确定SBL增加的独立危险因素。
本系列包括77例LLR和181例OLR。整个队列中有3例血栓栓塞事件（1.2%），而66例患者（25.6%）出现SBL增加（≥500 mL），8例患者（3.1%）出现术后出血并发症（BCs）。在ATT组和非ATT组中，尽管LLR作为解剖性切除的比例较低，但LLR均与SBL减少和BCs发生率低显著相关。多因素分析显示，在整个队列中，解剖性肝切除术是SBL增加的最显著危险因素[风险比（RR）=6.54，<0.001]，LLR也有显著的负面影响（RR=1/10.0，<0.001）。在分析ATT组患者时，观察到解剖性切除（RR=15.77，<0.001）和LLR（RR=1/5.88，=0.019）有相同的影响。
即使在有血栓栓塞风险且接受抗栓治疗的患者中，采用双术者技术的LLR也是可行且安全的。无论肝切除范围如何，在ATT组和非ATT组中，LLR均与SBL减少显著相关。
