中央肝切除术与扩大肝切除术的结果。

Outcomes of central hepatectomy versus extended hepatectomy.

机构信息

Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Melbourne, Victoria, Australia.

Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Northern Health, Epping, Victoria, Australia.

出版信息

Hepatobiliary Pancreat Dis Int. 2019 Jun;18(3):249-254. doi: 10.1016/j.hbpd.2019.03.005. Epub 2019 Mar 26.

DOI:10.1016/j.hbpd.2019.03.005

PMID:30987899

Abstract

BACKGROUND

Central hepatectomy (CH) is more difficult than extended hepatectomy (EH) and is associated with greater morbidity. In this modern era of liver management with aims to prevent post-hepatectomy liver failure (PHLF), there is a need to assess outcomes of CH as a parenchyma-sparing procedure for centrally located liver tumors.

METHODS

A total of 178 major liver resections performed by specialist surgeons from two Australian tertiary institutions between June 2009 and March 2017 were reviewed. Eleven patients had CH and 24 had EH over this study period. Indications and perioperative outcomes were compared between the groups.

RESULTS

The main indication for performing CH was colorectal liver metastases. There was no perioperative mortality in the CH group and four (16.7%) in the EH group (P = 0.285). No group differences were found in median operative time [CH vs. EH: 450 min (290-840) vs. 523 min (310-860), P = 0.328], intraoperative blood loss [850 mL (400-1500) vs. 650 mL (100-2000), P = 0.746] or patients requiring intraoperative blood transfusion [1 (9.1%) vs. 7 (30.4%), P = 0.227]. There was a trend towards fewer hepatectomy-specific complications in the CH group [3 (27.3%) vs. 13 (54.2%), P = 0.167], including PHLF (CH vs. EH: 0 vs. 29.2%, P = 0.072). Median length of stay was similar between groups [CH vs. EH: 9 days (5-23) vs. 12 days (4-85), P = 0.244].

CONCLUSIONS

CH has equivalent postoperative outcomes to EH. There is a trend towards fewer hepatectomy-specific complications, including PHLF. In appropriate patients, CH may be considered as a safe parenchyma-sparing alternative to EH.

摘要

背景

中央肝切除术（CH）比扩大肝切除术（EH）更具难度，且发病率更高。在当前以预防肝切除术后肝功能衰竭（PHLF）为目标的肝脏管理时代，需要评估 CH 作为中央部位肝脏肿瘤保留肝实质的手术方式的治疗效果。

方法

回顾分析了 2009 年 6 月至 2017 年 3 月期间，两位澳大利亚三级机构的专家外科医生完成的 178 例大肝切除术患者的资料。研究期间，11 例患者接受 CH，24 例患者接受 EH。对两组患者的适应证和围手术期结果进行了比较。

结果

CH 的主要适应证是结直肠肝转移。CH 组无围手术期死亡，EH 组有 4 例（16.7%）（P=0.285）。两组间的中位手术时间[CH 与 EH：450 分钟（290-840）与 523 分钟（310-860），P=0.328]、术中出血量[850 毫升（400-1500）与 650 毫升（100-2000），P=0.746]或术中需要输血的患者比例[1 例（9.1%）与 7 例（30.4%），P=0.227]无差异。CH 组肝切除术相关并发症发生率较低[3 例（27.3%）与 13 例（54.2%），P=0.167]，包括 PHLF（CH 与 EH：0 例与 29.2%，P=0.072）。两组中位住院时间相似[CH 与 EH：9 天（5-23）与 12 天（4-85），P=0.244]。