Kobayashi T, Miura K, Ishikawa H, Soma D, Ando T, Yuza K, Hirose Y, Katada T, Takizawa K, Nagahashi M, Sakata J, Kameyama H, Wakai T
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Transplant Proc. 2018 Nov;50(9):2597-2600. doi: 10.1016/j.transproceed.2018.03.035. Epub 2018 Mar 16.
We have introduced and performed laparoscope-assisted surgery in living donor hepatectomy. The objective of this study was to investigate the long-term results of laparoscope-assisted living donor hepatectomy.
From 2006 to 2016, laparoscope-assisted living donor hepatectomy was performed in 11 patients (laparoscopic group), and conventional open living donor hepatectomy was performed in 40 patients (conventional group). Intraoperative and postoperative complications were evaluated according to the Clavien-Dindo classification and analyzed in the laparoscopic group for comparison with the conventional group.
The median postoperative follow-up period was 88 months (range, 58-120 months) in the laparoscopic group. One donor in the conventional group died from a motor vehicle crash 16 months after surgery. All others were alive and returned to their preoperative activity level. Regarding intraoperative and early (≤90 days after surgery) postoperative complications, 1 patient (1/11, 9%) showed biliary fistula (Grade IIIa) in the laparoscopic group. In the conventional group, 6 patients (6/40, 15%) showed surgical complications of Grade I in 2 patients and Grade II in 4 patients. Regarding late (>90 days after surgery) postoperative complications, biliary stricture was observed in 1 patient of the laparoscopic group; this patient developed hepatolithiasis 6 years after surgery, and endoscopic lithotomy and extracorporeal shockwave lithotripsy were performed, resulting in successful treatment. Late complications were not observed in the conventional group.
One donor in the laparoscopic group showed Grade IIIa late complications. The introduction of laparoscopic surgery to living donor hepatectomy should be performed carefully.
我们已在活体肝移植供体肝切除术中引入并开展了腹腔镜辅助手术。本研究的目的是探讨腹腔镜辅助活体肝移植供体肝切除术的长期效果。
2006年至2016年期间，对11例患者实施了腹腔镜辅助活体肝移植供体肝切除术（腹腔镜组），并对40例患者实施了传统开放性活体肝移植供体肝切除术（传统组）。根据Clavien-Dindo分类法评估术中及术后并发症，并在腹腔镜组中进行分析，以与传统组进行比较。
腹腔镜组术后中位随访期为88个月（范围58 - 120个月）。传统组中有1例供体在术后16个月死于机动车事故。其他所有供体均存活，并恢复到术前的活动水平。关于术中及术后早期（术后≤90天）并发症，腹腔镜组有1例患者（1/11，9%）出现胆瘘（Ⅲa级）。在传统组中，6例患者（6/40，15%）出现手术并发症，其中2例为Ⅰ级，4例为Ⅱ级。关于术后晚期（术后>90天）并发症，腹腔镜组有1例患者出现胆管狭窄；该患者在术后6年发生肝内胆管结石，接受了内镜下取石和体外冲击波碎石治疗，治疗成功。传统组未观察到晚期并发症。
腹腔镜组有1例供体出现Ⅲa级晚期并发症。在活体肝移植供体肝切除术中引入腹腔镜手术应谨慎进行。
