Rhu Jinsoo, Choi Gyu Seong, Kim Jong Man, Kwon Choon Hyuck David, Joh Jae-Won
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Ann Transplant. 2019 Feb 28;24:115-122. doi: 10.12659/AOT.914013.
BACKGROUND The purpose of this study was to investigate the feasibility of using intraoperative ultrasonography as a guidance in dividing bile duct during laparoscopic donor hepatectomy. MATERIAL AND METHODS Cases of living liver donors who underwent laparoscopic living donor hepatectomy from May 2013 to December 2017 were reviewed. Operative and postoperative data were compared between donors with intraoperative ultrasonography and donors with intraoperative cholangiography. For analyzing whether bile duct division was performed successfully, anatomical type and number of bile duct openings were reviewed. When the number of bile ducts were achieved as expected, it was considered "successful". RESULTS Intraoperative cholangiography was used in 67 donors (62.6%) while intraoperative ultrasonography was used in 36 donors (33.6%). Mean operation time was 405.0±76.2 minutes versus 275.1±37.5 minutes, P<0.001, respectively, and was longer in donors who had a cholangiography. There was no difference in the success rate of bile duct division between donors who had a cholangiography (92.5%) and donors who had an ultrasonography (88.9%, P=0.716). The mean hospital stay after operation was longer in donors who had a cholangiography (11.6±4.3 days versus 9.0±2.7 days, P<0.001). There was no difference in biliary complication rate between donors who had a cholangiography (11.9%) and donors who had an ultrasonography (8.3%, P=0.743). CONCLUSIONS Intraoperative ultrasonography can be used safely in dividing bile duct during laparoscopic living donor hepatectomy with similar outcomes to intraoperative cholangiography.
背景 本研究的目的是探讨在腹腔镜供肝切除术中使用术中超声作为胆管分离引导的可行性。材料与方法 回顾了2013年5月至2017年12月期间接受腹腔镜活体供肝切除术的活体肝供者病例。比较了术中使用超声的供者和术中使用胆管造影的供者的手术及术后数据。为分析胆管分离是否成功进行，回顾了胆管的解剖类型和开口数量。当胆管数量达到预期时，视为“成功”。结果 67例供者（62.6%）使用了术中胆管造影，36例供者（33.6%）使用了术中超声。平均手术时间分别为405.0±76.2分钟和275.1±37.5分钟，P<0.001，接受胆管造影的供者手术时间更长。接受胆管造影的供者（92.5%）和接受超声检查的供者（88.9%，P=0.716）胆管分离成功率无差异。接受胆管造影的供者术后平均住院时间更长（11.6±4.3天对9.0±2.7天，P<0.001）。接受胆管造影的供者（11.9%）和接受超声检查的供者（8.3%，P=0.743）胆道并发症发生率无差异。结论 术中超声可安全用于腹腔镜活体供肝切除术中胆管分离，其结果与术中胆管造影相似。
