Assis Bruno Silva de, Coelho Fabricio Ferreira, Jeismann Vagner Birk, Kruger Jaime Arthur Pirola, Fonseca Gilton Marques, Cecconello Ivan, Herman Paulo
Postgraduate Course in Digestive Surgery, Colégio Brasileiro de Cirurgia Digestiva, São Paulo, Brazil.
Department of Gastroenterology, School of Medicine, Universityof São Paulo, São Paulo, Brazil.
Arq Bras Cir Dig. 2020;33(1):e1494. doi: 10.1590/0102-672020190001e1494. Epub 2020 May 18.
There have been an increasing number of articles that demonstrate the potential benefits of minimally invasive liver surgery in recent years. Most of the available evidence, however, comes from retrospective observational studies susceptible to bias, especially selection bias. In addition, in many series, several modalities of minimally invasive surgery are included in the same comparison group.
To compare the perioperative results (up to 90 days) of patients submitted to total laparoscopic liver resection with those submitted to open liver resection, matched by propensity score matching (PSM).
Consecutive adult patients submitted to liver resection were included. PSM model was constructed using the following variables: age, gender, diagnosis (benign vs. malignant), type of hepatectomy (minor vs. major), and presence of cirrhosis. After matching, the groups were redefined on a 1:1 ratio, by the nearest method.
After matching, 120 patients were included in each group. Those undergoing total laparoscopic surgery had shorter operative time (286.8±133.4 vs. 352.4±141.5 minutes, p<0.001), shorter ICU stay (1.9±1.2 vs. 2.5±2.2days, p=0.031), shorter hospital stay (5.8±3.9 vs. 9.9±9.3 days, p<0.001) and a 45% reduction in perioperative complications (19.2 vs. 35%, p=0.008).
Total laparoscopic liver resections are safe, feasible and associated with shorter operative time, shorter ICU and hospital stay, and lower rate of perioperative complications.
近年来，越来越多的文章证明了微创肝脏手术的潜在益处。然而，大多数现有证据来自易受偏倚影响的回顾性观察性研究，尤其是选择偏倚。此外，在许多系列研究中，同一比较组纳入了几种微创手术方式。
通过倾向评分匹配（PSM）比较接受全腹腔镜肝切除术患者与接受开放性肝切除术患者的围手术期结果（至90天）。
纳入接受肝切除术的连续成年患者。使用以下变量构建PSM模型：年龄、性别、诊断（良性与恶性）、肝切除术类型（小手术与大手术）和肝硬化情况。匹配后，通过最近邻法将两组按1:1比例重新定义。
匹配后，每组纳入120例患者。接受全腹腔镜手术的患者手术时间较短（286.8±133.4对352.4±141.5分钟，p<0.001），ICU住院时间较短（1.9±1.2对2.5±2.2天，p=0.031），住院时间较短（5.8±3.9对9.9±9.3天，p<0.001），围手术期并发症减少45%（19.2%对35%，p=0.008）。
全腹腔镜肝切除术安全、可行，且手术时间短、ICU和住院时间短，围手术期并发症发生率低。
