Hepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan.
Okinaka Memorial Institute for Medical Disease, Tokyo, Japan.
World J Surg. 2020 Dec;44(12):4214-4220. doi: 10.1007/s00268-020-05743-4. Epub 2020 Aug 17.
Adhesion barriers are increasingly used in hepatobiliary surgery. However, there has been no solid evidence yet in support of their safety.
Incidences of global postoperative morbidities and major abdominal morbidities were compared between 101 consecutive patients who received a sheet-type adhesion barrier (Interceed) and 134 patients who did not receive any adhesion barriers during hepatectomy. Propensity score (PS) adjustment was used to account for potential bias to receive Interceed.
In the PS-adjusted population, the incidences of both global postoperative morbidities and major abdominal morbidities showed no significant difference between the Interceed group and the control group (17.9% vs. 17.6%; P = 0.948 and 7.8% vs. 9.1%; P = 0.813, respectively). Multivariate analysis showed that age + 10 years (odds ratio [OR], 1.70; 95% CI, 1.15-2.50; P = 0.007), estimated blood loss + 100 mL (OR, 1.05; 95% CI, 1.01-1.09, P = 0.009), and laparoscopic approach (OR, 0.10; 95% CI, 0.01-0.75; P = 0.026) were independent predictors for global postoperative morbidities and operation time + 1 h (OR, 1.56; 95% CI, 1.23-1.96; P < 0.001) was a risk factor for major abdominal morbidity, while no specific association between the use of Interceed and the risk of postoperative morbidity was observed.
Use of Interceed does not increase the risk of postoperative morbidities after hepatectomy.
黏连屏障在肝胆外科手术中应用日益广泛,但目前尚无确切证据支持其安全性。
比较 101 例连续接受片状黏连屏障(Interceed)的患者和 134 例未使用任何黏连屏障的患者的全术后并发症和主要腹部并发症发生率。采用倾向评分(PS)调整来控制接受 Interceed 的潜在偏倚。
在 PS 调整后的人群中,Interceed 组和对照组的全术后并发症和主要腹部并发症发生率均无显著差异(17.9%比 17.6%;P=0.948 和 7.8%比 9.1%;P=0.813)。多变量分析显示,年龄+10 岁(比值比[OR],1.70;95%置信区间[CI],1.15-2.50;P=0.007)、估计出血量+100ml(OR,1.05;95%CI,1.01-1.09,P=0.009)和腹腔镜手术(OR,0.10;95%CI,0.01-0.75;P=0.026)是全术后并发症的独立预测因素,手术时间+1 小时(OR,1.56;95%CI,1.23-1.96;P<0.001)是主要腹部并发症的危险因素,而使用 Interceed 与术后并发症风险之间没有特定关联。
在肝切除术后使用 Interceed 不会增加术后并发症的风险。