Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, 37 Guo Xue Road, Chengdu, 610041, Sichuan, China.
Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Surg Endosc. 2018 May;32(5):2454-2465. doi: 10.1007/s00464-017-5947-5. Epub 2017 Nov 9.
LigaSure has been reported as a safe and effective approach for parenchymal transection in open hepatectomy; however, its roles in laparoscopic hepatectomy (LH) with liver cirrhosis have not been evaluated. The aim of this study was to compare the outcomes of LigaSure vs. Cavitron Ultrasonic Surgical Aspirator (CUSA) for LH in hepatocellular carcinoma (HCC) patients with cirrhosis.
We retrospectively reviewed the medical records of 135 HCC patients with background cirrhosis who underwent pure LH using CUSA (n = 55) or LigaSure (n = 80) for parenchymal transection between January 2015 and May 2017 at West China Hospital of Sichuan University. We performed 1:1 propensity score matching between the LigaSure and CUSA groups. Subsequently, 48 patients were included in each group.
The mean parenchymal transection time (74.3 ± 23.6 vs. 86.3 ± 25.8 min, P = 0.019) in the LigaSure group was obviously shorter than that in the CUSA group. The LigaSure did not increase the intraoperative blood loss or blood transfusion requirement when compared with CUSA. Moreover, the degree of postoperative reperfusion injury and complications were not significantly different between the two groups. Furthermore, there were no significant differences between the two groups regarding 2-year overall survival rate or disease-free survival rate. In addition, the total hospitalization costs (P = 0.032) and intraoperative costs (P = 0.006) per case were significantly lower in the LigaSure group than those in the CUSA group.
The two devices were safe and effective for LH in patients with cirrhosis. The LigaSure method may be a simple, feasible, and cost-effective surgical technique for LH in selected HCC patients with cirrhosis.
LigaSure 已被报道为一种安全有效的开腹肝切除术实质切开方法; 然而，其在合并肝硬化的腹腔镜肝切除术 (LH) 中的作用尚未得到评估。本研究旨在比较 LigaSure 与 Cavitron 超声外科吸引器 (CUSA) 在合并肝硬化的肝细胞癌 (HCC) 患者 LH 中的作用。
我们回顾性分析了 2015 年 1 月至 2017 年 5 月在四川大学华西医院行单纯 LH 的 135 例合并肝硬化的 HCC 患者的病历资料，其中使用 CUSA (n = 55) 或 LigaSure (n = 80) 进行实质切开。我们在 LigaSure 组和 CUSA 组之间进行了 1:1 的倾向评分匹配。随后，每组纳入 48 例患者。
LigaSure 组的平均实质切开时间 (74.3 ± 23.6 分钟比 86.3 ± 25.8 分钟，P = 0.019) 明显短于 CUSA 组。与 CUSA 相比，LigaSure 并未增加术中出血量或输血需求。此外，两组患者术后再灌注损伤和并发症的严重程度无显著差异。此外，两组患者的 2 年总生存率或无病生存率无显著差异。此外，LigaSure 组的总住院费用 (P = 0.032) 和术中费用 (P = 0.006) 明显低于 CUSA 组。
两种器械均安全有效，适用于肝硬化患者的 LH。在选择的合并肝硬化的 HCC 患者中，LigaSure 方法可能是一种简单、可行且具有成本效益的 LH 手术技术。
