Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI.
Liver Transpl. 2018 Apr;24(4):516-527. doi: 10.1002/lt.25001.
Although minimally invasive techniques for living donor hepatectomy have been developed, the surgical feasibility and limitations remain to be elucidated. The risks and outcomes involved need to be better understood prior to their widespread application. The aim of this study was to assess feasibility of minimally invasive donor hepatectomy by reviewing our experience. A total of 99 living donor liver transplantations performed between 2000 and 2016 were retrospectively reviewed. All 99 living liver donors underwent right hepatectomy. The breakdown of the techniques is as follows: the standard technique in 33 patients; the laparoscopic-assisted minilaparotomy technique (hybrid technique group) in 19 patients; and the upper midline incision technique without laparoscopic assistance (minilaparotomy group) in 47 patients. An association between donor operative outcomes and body habitus, such as body mass index (BMI), abdominal truncal depth (approximated by celiac axis [CA] depth ratio), and umbilical circumference (UC) were assessed. Perioperative factors were compared between the standard technique and the minimally invasive technique. The minilaparotomy group had significantly shorter operative time (P = 0.046) and hospital stay (P = 0.005) than the standard technique group. Postoperative complication rates were similar between the 3 groups (P = 0.16). In the minilaparotomy group, greater BMI (P = 0.02), CA depth ratio (P = 0.04), and UC (P = 0.004) were found to be risk factors for postoperative complications. In the minilaparotomy group, CA depth ratio > 0.41, UC > 90 cm, and BMI > 30 kg/m were significantly associated with longer operative time and hospital stay. In the standard technique group, none of the body size factors were associated with postoperative outcomes. In conclusion, the minilaparotomy technique is safe and feasible, though technical difficulties may be encountered when performed on donors with larger body habitus. Ongoing efforts are required to ensure living donor safety. Liver Transplantation 24 516-527 2018 AASLD.
虽然已经开发出了微创技术用于活体供肝切除术，但手术的可行性和局限性仍有待阐明。在广泛应用之前，需要更好地了解所涉及的风险和结果。本研究旨在通过回顾我们的经验来评估微创供肝切除术的可行性。回顾性分析了 2000 年至 2016 年期间进行的 99 例活体肝移植供者。所有 99 例活体肝供者均行右半肝切除术。手术技术如下：标准技术 33 例；腹腔镜辅助小切口技术（杂交技术组）19 例；无腹腔镜辅助的中上腹部正中切口技术（小切口组）47 例。评估了供者手术结果与身体形态之间的关系，例如体重指数（BMI）、腹腔干（CA）深度比和脐周长（UC）。比较了标准技术与微创技术之间的围手术期因素。小切口组的手术时间（P = 0.046）和住院时间（P = 0.005）明显短于标准技术组。3 组术后并发症发生率无差异（P = 0.16）。在小切口组中，BMI（P = 0.02）、CA 深度比（P = 0.04）和 UC（P = 0.004）越大，术后并发症的风险越高。在小切口组中，CA 深度比＞0.41、UC＞90cm 和 BMI＞30kg/m2 与手术时间和住院时间延长显著相关。在标准技术组中，没有任何身体尺寸因素与术后结果相关。总之，小切口技术是安全可行的，但对于体型较大的供者，可能会遇到技术困难。需要继续努力确保活体供者的安全。肝移植 24 516-527 2018 AASLD。
