Rhu Jinsoo, Kim Jong Man, Choi Gyu Seong, Kwon Choon Hyuck David, Joh Jae-Won, Soubrane Olivier
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Hepatobiliary-Pancreatic Surgery, Hospital Beaujon, APHP, Clichy, France.
Ann Surg Treat Res. 2018 Nov;95(5):258-266. doi: 10.4174/astr.2018.95.5.258. Epub 2018 Oct 25.
This study analyzes the impact of laparoscopic liver resection on intra-abdominal adhesion.
Patients who underwent salvage liver transplantation after liver resection for hepatocellular carcinoma from January 2012 to October 2017 at our institution were included. Information about the severity of intra-abdominal adhesions was collected from a prospectively maintained database. Intra-abdominal adhesions were graded after the agreement of 2 surgeons who participated in the salvage liver transplantation based on predetermined criteria. Adhesion severity and demographic, operative, and postoperative data were compared between the laparoscopic group and the open group. Multivariate logistic regression was performed to consider potential factors related to severe adhesion during salvage transplantation.
Sixty-two patients who underwent salvage liver transplantation after liver resection were included in this study. Among them, 52 patients underwent open surgery, and 10 patients underwent laparoscopy. Adhesion was significantly more severe in the open group than in the laparoscopy group (P = 0.029). A multivariate logistic regression model including potential factors related to severe adhesion showed that laparoscopy (odds ratio, 0.168; 95% confidence interval, 0.029-0.970; P = 0.048) was the only significant factor.
Laparoscopic liver resection for hepatocellular carcinoma can minimize intra-abdominal adhesion during salvage liver transplantation.
本研究分析腹腔镜肝切除术对腹腔内粘连的影响。
纳入2012年1月至2017年10月在本机构因肝细胞癌肝切除术后接受挽救性肝移植的患者。腹腔内粘连严重程度的信息从一个前瞻性维护的数据库中收集。在参与挽救性肝移植的2名外科医生根据预定标准达成一致后，对腹腔内粘连进行分级。比较腹腔镜组和开放手术组的粘连严重程度以及人口统计学、手术和术后数据。进行多因素逻辑回归分析以考虑挽救性移植期间与严重粘连相关的潜在因素。
本研究纳入了62例肝切除术后接受挽救性肝移植的患者。其中，52例患者接受了开放手术，10例患者接受了腹腔镜手术。开放手术组的粘连明显比腹腔镜组严重（P = 0.029）。一个包含与严重粘连相关潜在因素的多因素逻辑回归模型显示，腹腔镜手术（比值比，0.168；95%置信区间，0.029 - 0.970；P = 0.048）是唯一的显著因素。
肝细胞癌的腹腔镜肝切除术可在挽救性肝移植期间将腹腔内粘连降至最低。
