Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Transplantation. 2019 Oct;103(10):e308-e316. doi: 10.1097/TP.0000000000002834.
The innovative pure laparoscopic living donor right hepatectomy (LLDRH) procedure for liver transplantation has never been fully compared to open living donor right hepatectomy (OLDRH). We aimed to compare the donor safety and graft results of pure LLDRH to those of OLDRH.
From May 2013 to July 2017, 288 consecutive donors underwent either OLDRH (n = 197) or pure LLDRH (n = 91). After propensity score matching, 72 donors were included in each group. The primary outcome was postoperative complications during a 90-day follow-up period. Comprehensive complication index, duration of hospital stay, need for additional pain control, readmission, and donor outcomes were also compared.
The incidence of major complication during the 90-day follow-up was higher in the LLDRH group than the OLDRH group (6.6% vs 15.4%, P = 0.017) but was not statistically significant in propensity-matched analysis (11.1% vs 13.9%, odds ratio [OR], 1.29; 95% confidence interval [CI], 0.47-3.51; P = 0.62). A right hepatic duct <1 cm was independently associated with complication in the pure LLDRH group (odds ratio, 4.01; 95% confidence interval, 1.08-14.99; P = 0.04).
In the initial 91 pure LLDRH cases, incidence of major complication was higher than in the OLDRH group, but the difference was not significant in propensity-matched analysis. A right hepatic duct verified as <1 cm may be related to increased frequency of complications in pure LLDRH donors. Further analysis is needed.
创新的纯腹腔镜活体供肝右半肝切除术（LLDRH）用于肝移植，从未与开放性活体供肝右半肝切除术（OLDRH）完全比较过。我们旨在比较纯 LLDRH 与 OLDRH 的供体安全性和移植物结果。
从 2013 年 5 月至 2017 年 7 月，连续 288 例供体接受了 OLDRH（n = 197）或纯 LLDRH（n = 91）。在进行倾向评分匹配后，每组纳入 72 例供体。主要结局是 90 天随访期间的术后并发症。还比较了综合并发症指数、住院时间、需要额外止痛控制、再次入院和供体结局。
LLDRH 组在 90 天随访期间的主要并发症发生率高于 OLDRH 组（6.6%比 15.4%，P = 0.017），但在倾向评分匹配分析中差异无统计学意义（11.1%比 13.9%，比值比 [OR]，1.29；95%置信区间 [CI]，0.47-3.51；P = 0.62）。右肝管<1 cm 与纯 LLDRH 组的并发症独立相关（OR，4.01；95%CI，1.08-14.99；P = 0.04）。
在最初的 91 例纯 LLDRH 病例中，主要并发症的发生率高于 OLDRH 组，但在倾向评分匹配分析中差异无统计学意义。证实<1 cm 的右肝管可能与纯 LLDRH 供体并发症的发生频率增加有关。需要进一步分析。
