Hasegawa Yasushi, Nitta Hiroyuki, Takahara Takeshi, Katagiri Hirokatsu, Kanno Shoji, Otsuka Koki, Sasaki Akira
Department of Surgery Iwate Medical University School of Medicine Morioka City Iwate Japan.
Ann Gastroenterol Surg. 2018 Jul 13;2(5):376-382. doi: 10.1002/ags3.12193. eCollection 2018 Sep.
As a procedure, major laparoscopic liver resection (LLR) remains in the exploration phase. Previous studies have assessed major LLR en bloc, including hepatectomies of varying complexities; however, the number of segments alone does not convey the complexity of a resection. This study aimed to assess operative outcomes of LLR procedures with more than one sectionectomy, and to identify the best procedure as a first step when learning to carry out major LLR in order to make LLR a safer, more widely used procedure.
We carried out a retrospective review of the operative outcomes of 120 consecutive patients who underwent pure LLR with more than one sectionectomy. Operative outcomes were compared according to the complexity classification recently published, and the learning curve for each LLR procedure was assessed and compared.
Operative outcomes, including operative time, blood loss, and the comprehensive complication index, were significantly stratified according to complexity. There were significant differences in operative outcomes among the medium complexity procedures. The operative time for left hemihepatectomy was the shortest, and the amount of blood loss was the lowest among the medium complexity LLR. Operative times for left hemihepatectomy shortened significantly with time and experience ( = -0.639), and the slope of the learning curve was steeper than for right hemihepatectomy and right posterior sectionectomy.
Left hemihepatectomy is suitable as a first step in pure laparoscopic major hepatectomy and, given its safety and rapid learning curve for surgeons, it could become the gold standard procedure.
作为一种手术方式，腹腔镜下肝大部切除术（LLR）仍处于探索阶段。既往研究对整块肝大部切除术进行了评估，包括不同复杂程度的肝切除术；然而，仅节段数量并不能体现切除术的复杂程度。本研究旨在评估多节段切除术的LLR手术效果，并确定在学习开展腹腔镜下肝大部切除术时作为第一步的最佳术式，以使LLR成为一种更安全、应用更广泛的手术。
我们对120例连续接受多节段切除术的单纯LLR患者的手术效果进行了回顾性分析。根据最近发表的复杂性分类比较手术效果，并评估和比较每种LLR手术的学习曲线。
手术效果，包括手术时间、失血量和综合并发症指数，根据复杂性进行了显著分层。中等复杂程度手术的手术效果存在显著差异。在中等复杂程度的LLR中，左半肝切除术的手术时间最短，失血量最少。左半肝切除术的手术时间随时间和经验显著缩短（=-0.639），其学习曲线斜率比右半肝切除术和右后段切除术更陡。
左半肝切除术适合作为单纯腹腔镜下肝大部切除术的第一步，鉴于其安全性和对外科医生而言快速的学习曲线，它可能成为金标准术式。
