腹腔镜与开腹肝后上段切除术的比较：OSLO-COMET 随机对照试验的亚组分析。
Laparoscopic versus open liver resection in the posterosuperior segments: a sub-group analysis from the OSLO-COMET randomized controlled trial.
机构信息
The Intervention Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Norway; Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia.
The Intervention Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Norway; Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
出版信息
HPB (Oxford). 2019 Nov;21(11):1485-1490. doi: 10.1016/j.hpb.2019.03.358. Epub 2019 Apr 5.
BACKGROUND
Laparoscopic liver resection in the posterosuperior segments is technically challenging. This study aimed to compare the perioperative outcomes for laparoscopic and open resection of colorectal liver metastases located in the posterosuperior segments.
METHODS
This was a subgroup analysis of the OSLO-COMET randomized controlled trial, where 280 patients were randomly assigned to open or laparoscopic parenchyma-sparing liver resections of colorectal metastases. Patients with tumors in the posterosuperior segments were identified, and perioperative outcomes and health related quality of life (HRQoL) were compared.
RESULTS
We identified a total of 136 patients, 62 in the laparoscopic and 74 in the open group. The postoperative complication rate was 26% in the laparoscopic and 31% in the open group. The blood loss was less in the open group (500 vs. 250 ml, P = 0.006), but the perioperative transfusion rate was similar. The operative time was similar, while postoperative hospital stay was shorter in the laparoscopic group (2 vs. 4 days, P < 0.001). HRQoL was significantly better after laparoscopy at 1 month.
CONCLUSION
In patients undergoing laparoscopic or open liver resection of colorectal liver metastases in the posterosuperior segments, laparoscopic surgery was associated with shorter hospital stay and comparable perioperative outcomes.
背景
腹腔镜肝切除术在后上部位具有一定的技术挑战性。本研究旨在比较腹腔镜与开腹切除结直肠肝转移瘤后上部位的围手术期结果。
方法
这是 OSLO-COMET 随机对照试验的亚组分析，其中 280 例患者被随机分配至开腹或腹腔镜保留肝实质的结直肠转移瘤切除术。识别出肿瘤位于后上部位的患者，并比较围手术期结果和健康相关生活质量（HRQoL）。
结果
共纳入 136 例患者，腹腔镜组 62 例，开腹组 74 例。腹腔镜组的术后并发症发生率为 26%，开腹组为 31%。开腹组的出血量较少（500 比 250ml，P=0.006），但围手术期输血率相似。手术时间相似，而腹腔镜组的术后住院时间较短（2 比 4 天，P<0.001）。腹腔镜组术后 1 个月的 HRQoL 显著改善。
结论
对于接受腹腔镜或开腹切除结直肠肝转移瘤后上部位的患者，腹腔镜手术与较短的住院时间和相当的围手术期结果相关。
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