Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi, 463-707, Republic of Korea.
Surg Endosc. 2021 Mar;35(3):1148-1155. doi: 10.1007/s00464-020-07479-7. Epub 2020 Mar 9.
A difficulty scoring system (DSS) based on the extent of liver resection, tumor location, liver function, tumor size, and tumor proximity to major vessels was previously developed to assess the difficulty of laparoscopic liver resection (LLR). Recently, we proposed a modified DSS for patients who undergo LLR for intrahepatic duct (IHD) stones. In this study, we validated the modified DSS for LLR for IHD stones.
We reviewed the clinical data of 121 patients who underwent LLR for IHD stones between July 2003 and November 2015 and validated the modified DSS in patients who underwent LLR according to their surgical outcomes. We divided the patients into subgroups according to their scores and compared the surgical outcomes, including hospital stay, operation time, blood loss, transfusion rate, and the postoperative complication rate and grade, among the subgroups of patients.
The DSS score ranged from 3 to 12 in LLR for IHD stones. The operation time (P < 0.001) significantly increased according to the DSS score. The median hospital stay after surgery (P = 0.024) and transfusion rate (P = 0.001) were significantly different among subgroups of patients divided by their difficulty scores. When we divided the patients into two groups based on the side of liver of resected, the operation time (P < 0.001), mean difficulty score (P < 0.001), and blood loss (P = 0.041) were greater in patients who underwent right liver resection.
The surgical difficulty varies among patients undergoing the same LLR procedure for IHD stones. The modified DSS for IHD stones can effectively predict the surgery outcomes and complications of LLR.
先前开发了一种基于肝切除范围、肿瘤位置、肝功能、肿瘤大小以及肿瘤与大血管毗邻程度的困难评分系统（DSS），以评估腹腔镜肝切除术（LLR）的难度。最近，我们提出了一种改良的 DSS，用于接受 LLR 治疗肝内胆管（IHD）结石的患者。在这项研究中，我们验证了改良的 DSS 用于治疗 IHD 结石的 LLR。
我们回顾了 2003 年 7 月至 2015 年 11 月期间 121 例接受 LLR 治疗 IHD 结石的患者的临床资料，并根据手术结果验证了改良的 DSS。我们根据 DSS 评分将患者分为亚组，并比较了亚组患者的手术结果，包括住院时间、手术时间、出血量、输血率以及术后并发症的发生率和严重程度。
LR 治疗 IHD 结石的 DSS 评分范围为 3 至 12 分。手术时间（P < 0.001）随 DSS 评分的增加而显著增加。根据困难评分，术后住院时间中位数（P = 0.024）和输血率（P = 0.001）在患者亚组之间存在显著差异。当我们根据切除肝的侧别将患者分为两组时，右半肝切除术患者的手术时间（P < 0.001）、平均难度评分（P < 0.001）和出血量（P = 0.041）均较大。
接受相同 LLR 治疗 IHD 结石的患者手术难度存在差异。改良的 IHD 结石 DSS 可有效预测 LLR 的手术结果和并发症。
