Department of Surgery, School of Medicine, Emory University, Atlanta, GA, USA; Winship Cancer Institute, Emory University, Atlanta, GA, USA.
Aga Khan University, Medical College, Karachi, Pakistan.
Am J Surg. 2019 Jan;217(1):66-70. doi: 10.1016/j.amjsurg.2018.08.014. Epub 2018 Aug 29.
Minimally invasive approaches for major hepatectomy have been marred by significant rates of conversion and associated morbidity. This study aimed to determine risk factors for conversion as well as postoperative morbidity in patients undergoing minimally invasive right-sided hepatectomy (MIRH).
Data for patients undergoing MIRH between 2008 and 2017 at Emory University were reviewed. Risk factors for conversion were determined using multivariate regression analysis. Outcomes of conversion patients were compared with those who underwent successful MIRH or elective open surgery.
Unplanned conversion occurred in 7 (6.25%) of 112 patients undergoing MIRH. Primary reason for conversion was difficult dissection secondary to inflammation and severe adhesions. No preoperative clinical factor was identified that predicted conversions. Converted cases had higher EBL and pRBC transfusion compared to non-converted cases however morbidity was similar to those undergoing primary open surgery.
Difficult dissection and adhesions remained the only clinically applicable parameter leading to unplanned conversions. While these did offset benefits of a successful minimally invasive approach, it did not increase risk of postoperative complications compared with planned open surgery.
微创方法进行大肝切除术存在较高的中转率和相关发病率。本研究旨在确定微创右半肝切除术（MIRH）患者中转的风险因素以及术后发病率。
回顾了 2008 年至 2017 年期间在埃默里大学接受 MIRH 的患者的数据。使用多变量回归分析确定中转的风险因素。将中转患者的结果与成功进行 MIRH 或择期开腹手术的患者进行比较。
112 例接受 MIRH 的患者中有 7 例（6.25%）发生了计划外中转。中转的主要原因是炎症和严重粘连导致的难以解剖。没有术前临床因素可以预测中转。与未中转的患者相比，中转患者的 EBL 和红细胞输注量更高，但与接受择期开腹手术的患者相比，其发病率相似。
难以解剖和粘连仍然是导致计划外中转的唯一具有临床意义的参数。虽然这确实抵消了微创成功的优势，但与计划开腹手术相比，并没有增加术后并发症的风险。
