Fuji Hiroaki, Seo Satoru, Toda Rei, Yoh Tomoaki, Ikeno Yoshinobu, Fukumitsu Ken, Ishii Takamichi, Taura Kojiro, Hatano Etsuro, Kaido Toshimi, Uemoto Shinji
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan.
Asian J Endosc Surg. 2019 Jul;12(3):287-293. doi: 10.1111/ases.12634. Epub 2018 Aug 21.
Surgery for Child-Pugh B liver function is considered risky because of its high morbidity rate and the acceptable indication criteria for laparoscopic liver resection (LLR) for Child-Pugh B patients have not been identified. We conducted a retrospective cohort study to determine the optimal introduction of LLR for Child-Pugh B patients based on our single-institute experience.
A total of 17 Child-Pugh B patients underwent LLR between 2005 and 2017. Their clinical outcomes were compared to those of LLR for Child-Pugh A patients (103 cases), conventional open liver resection for Child-Pugh B patients (19 cases), and radiofrequency ablation (RFA) for Child-Pugh B patients (20 cases) during the same period.
LLR for Child-Pugh B patients had a significantly higher conversion rate than LLR for Child-Pugh A patients (Child-Pugh A vs B: 3.9% vs 35.3%, P < 0.01). However, patients who successfully underwent laparoscopic resection (11 cases) had fewer postoperative ascites and shorter postoperative hospital stays compared to patients who underwent conventional open liver resection. In comparison to the RFA group, the LLR group more frequently had lesions in the left lateral segment (LLR vs RFA: 50.0% vs 10.0%, P = 0.02) and exophytic tumor (21.4% vs 0%, P = 0.02) than did the RFA group. Also, compared to the RFA group, the LLR group had a lower local recurrence rate (0% vs 15%, P = 0.25) and a longer recurrence-free survival (P = 0.049), but the overall survival was similar between the two groups.
In the treatment of Child-Pugh B liver malignancy, the minimal invasiveness of LLR was revealed. Our results suggest that lesions in the left lateral segment and exophytic tumors are good indications for LLR for Child-Pugh B.
由于Child-Pugh B级肝功能患者手术的高发病率，其手术被认为具有风险，且尚未确定Child-Pugh B级患者腹腔镜肝切除术（LLR）的可接受适应证标准。我们基于单中心经验进行了一项回顾性队列研究，以确定Child-Pugh B级患者LLR的最佳适应证。
2005年至2017年间，共有17例Child-Pugh B级患者接受了LLR。将他们的临床结果与同期Child-Pugh A级患者的LLR（103例）、Child-Pugh B级患者的传统开放性肝切除术（19例）以及Child-Pugh B级患者的射频消融术（RFA，20例）的结果进行比较。
Child-Pugh B级患者的LLR转化率显著高于Child-Pugh A级患者的LLR（Child-Pugh A级 vs B级：3.9% vs 35.3%，P < 0.01）。然而，成功接受腹腔镜切除术的患者（11例）与接受传统开放性肝切除术的患者相比，术后腹水更少，术后住院时间更短。与RFA组相比，LLR组左外叶病变（LLR vs RFA：50.0% vs 10.0%，P = 0.02）和外生性肿瘤（21.4% vs 0%，P = 0.02）的发生率更高。此外，与RFA组相比，LLR组局部复发率更低（0% vs 15%，P = 0.25），无复发生存期更长（P = 0.049），但两组总生存率相似。
在Child-Pugh B级肝脏恶性肿瘤的治疗中，LLR显示出微创性。我们的结果表明，左外叶病变和外生性肿瘤是Child-Pugh B级患者LLR的良好适应证。
