基于单外科医生经验的腹腔镜再次肝切除与腹腔镜原发性肝切除的围手术期结局分析：1:2 倾向评分匹配研究。

Analysis of perioperative outcomes following laparoscopic repeat liver resection compared to laparoscopic primary liver resection based on a single surgeon's experience: A 1:2 propensity score-matched study.

机构信息

Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Department of General Surgery, Sengkang General Hospital, Singapore.

出版信息

Surg Oncol. 2020 Dec;35:382-387. doi: 10.1016/j.suronc.2020.09.020. Epub 2020 Oct 2.

DOI:10.1016/j.suronc.2020.09.020

PMID:33035786

Abstract

BACKGROUND

We report a single surgeon experience with laparoscopic repeat liver resection (LRLR), and analyse short-term outcomes relative to laparoscopic primary liver resection (LPLR).

METHODS

Two-hundred and twenty-two laparoscopic liver resections were performed from 2012 to 2019 of which 33 were LRLR. 1:2 propensity-score matching was done to compare 32 LRLR with 64 LPLR cohort. We further analyzed the first 16 LRLR cases compared to the subsequent 17 cases.

RESULTS

32 LRLR cases were matched to 64 LPLR cases. Apart from a higher frequency of Pringle maneuver in the LPLR cohort (p = 0.006), there were no differences in other perioperative outcomes. There were more posterosuperior located tumours (75.0% vs 17.6%, p = 0.003) and higher median difficulty score (8.50 vs 5.00, p = 0.025) in the initial 16 LRLR cases compared to the next 17. The earlier group had higher median blood loss (250.00 ml vs 50.00 ml, p = 0.012), but other outcomes were similar.

CONCLUSION

LRLR may be safely performed in selected patients with no difference in key perioperative outcomes compared to LPLR.

摘要

背景

我们报告了一位外科医生的腹腔镜再次肝切除术（LRLR）经验，并分析了与腹腔镜原发性肝切除术（LPLR）相关的短期结果。

方法

2012 年至 2019 年期间进行了 222 例腹腔镜肝切除术，其中 33 例为 LRLR。采用 1:2 倾向评分匹配法比较了 32 例 LRLR 与 64 例 LPLR 队列。我们进一步分析了前 16 例 LRLR 病例与随后的 17 例病例。

结果

32 例 LRLR 病例与 64 例 LPLR 病例相匹配。除 LPLR 组中普林格尔操作的频率更高（p=0.006）外，其他围手术期结果无差异。后上叶肿瘤的发生率更高（75.0%比 17.6%，p=0.003），初始 16 例 LRLR 病例的中位难度评分（8.50 比 5.00，p=0.025）更高。与下一个 17 例病例相比，早期组的中位出血量更多（250.00 ml 比 50.00 ml，p=0.012），但其他结果相似。