Silva Jack P, Berger Nicholas G, Yin Ziyan, Liu Ying, Tsai Susan, Christians Kathleen K, Clarke Callisia N, Mogal Harveshp, Clark Gamblin T
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA.
HPB (Oxford). 2018 Feb;20(2):132-139. doi: 10.1016/j.hpb.2017.06.006. Epub 2017 Nov 26.
Surgical approach may influence morbidity following hepatectomy. This study sought to compare outcomes in minimally invasive surgery (MIS), conversion from MIS to open, and planned open hepatectomy patients and analyze factors leading to conversion.
The 2014 National Surgical Quality Improvement Program dataset was queried for patients undergoing hepatectomy. Patients were divided into three cohorts: MIS, open, or conversion. Propensity matching was performed to compare MIS vs. conversion (3:1) and open vs. conversion (8:1). The logistic regression model was used to identify odds ratios for conversion.
Patients undergoing conversion had a higher transfusion rate (26% vs. 9%, p < 0.001), longer length of stay (5 vs. 3 days, p < 0.001), and higher morbidity (38% vs. 18%, p < 0.001) than MIS patients. Patients who underwent conversion had similar short-term outcomes to those who had planned open procedures. Independent predictors of conversion included hypertension (OR 1.91; 95% CI 1.12-3.26) and right lobectomy (OR 20.23; 95% CI 3.74-109.35).
Patients with hypertension and those undergoing right lobectomy had a higher risk of conversion to open procedure. Conversion resulted in higher morbidity and longer length of stay compared to MIS patients, but outcomes were similar to planned open procedures.
手术方式可能会影响肝切除术后的发病率。本研究旨在比较微创手术（MIS）、MIS中转开腹手术以及计划性开腹肝切除患者的预后情况，并分析导致中转开腹的因素。
查询2014年国家外科质量改进计划数据集，纳入接受肝切除术的患者。患者分为三组：MIS组、开腹组或中转组。采用倾向评分匹配法比较MIS组与中转组（3:1）以及开腹组与中转组（8:1）。使用逻辑回归模型确定中转开腹的比值比。
中转开腹的患者与MIS患者相比，输血率更高（26%对9%，p<0.0０1），住院时间更长（5天对3天，p<0.0０1），发病率更高（38%对18%，p<0.0０1）。中转开腹的患者与计划性开腹手术的患者短期预后相似。中转开腹的独立预测因素包括高血压（比值比1.91；95%置信区间1.12-3.26）和右半肝切除术（比值比20.23；95%置信区间3.74-109.35）。
高血压患者和接受右半肝切除术的患者中转开腹的风险更高。与MIS患者相比，中转开腹导致更高的发病率和更长的住院时间，但预后与计划性开腹手术相似。
