Uchida Hiroki, Iwashita Yukio, Tada Kazuhiro, Saga Kunihiro, Takayama Hiroomi, Hirashita Teijiro, Endo Yuichi, Ohta Masayuki, Inomata Masafumi
Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan.
Langenbecks Arch Surg. 2018 May;403(3):371-377. doi: 10.1007/s00423-018-1671-4. Epub 2018 Apr 4.
Laparoscopic liver resection is widely used for liver tumors, but its utility in patients with cirrhosis remains controversial. The aim of this study was to assess the surgical outcomes of laparoscopic liver resection in patients with liver cirrhosis with specific reference to a difficulty scoring system.
From January 2010 to March 2016, the outcomes of laparoscopic liver resection in 95 patients were retrospectively reviewed. Surgical outcomes were analyzed to identify differences between the liver cirrhosis and non-liver cirrhosis groups; these groups were further stratified to high and low difficulty scores. The surgical outcomes of both groups were compared according to the difficulty scores.
Overall, 53/95 (55.8%) patients were diagnosed with liver cirrhosis. There were no significant differences in surgical duration, blood loss, postoperative hospital stay, and morbidity between groups, although liver function was worse in the liver cirrhosis group than in the non-liver cirrhosis group. Multivariate analysis showed that the difficulty score was an independent predictor of increased blood loss. In particular, blood loss in cirrhotic patients was significantly greater with a high difficulty score than with a low difficulty score.
The safety profile of laparoscopic liver resection was the same in patients with and without liver cirrhosis. However, patients with liver cirrhosis and a high difficulty score require extra attention, because of a higher risk for perioperative blood loss.
腹腔镜肝切除术广泛应用于肝肿瘤治疗，但在肝硬化患者中的应用仍存在争议。本研究旨在评估腹腔镜肝切除术在肝硬化患者中的手术效果，并特别参考难度评分系统。
回顾性分析2010年1月至2016年3月期间95例行腹腔镜肝切除术患者的手术结果。分析手术结果以确定肝硬化组和非肝硬化组之间的差异；这些组进一步分为高难度评分组和低难度评分组。根据难度评分比较两组的手术结果。
总体而言，95例患者中有53例（55.8%）被诊断为肝硬化。两组在手术时间、出血量、术后住院时间和发病率方面无显著差异，尽管肝硬化组的肝功能比非肝硬化组差。多因素分析显示，难度评分是出血量增加的独立预测因素。特别是，肝硬化患者中高难度评分组的出血量明显高于低难度评分组。
腹腔镜肝切除术在肝硬化患者和非肝硬化患者中的安全性相同。然而，肝硬化且难度评分高的患者需要格外关注，因为围手术期出血风险较高。
