Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.
Am Surg. 2020 Oct;86(10):1330-1336. doi: 10.1177/0003134820964442. Epub 2020 Oct 30.
There has been a significant increase in the use of laparoscopic liver resection (LLR) over the past 2 decades. This study aimed to analyze the outcomes associated with LLR at a single tertiary care hospital. Patients with benign or malignant tumors who underwent LLR by a single surgeon from January 2012 to November 2019 were identified. There were 123 patients who underwent LLR in the study period; 52% were men, and the median age was 61 (24-90) years. Five patients (4.1%) had unplanned conversion to open resection. Ninety-five patients (77.2%) had a wedge resection or single segmentectomy, and 28 (22.8%) underwent resection of 2+ liver segments. Seventy-one cases (57.7%) were for hepatocellular carcinoma (HCC), 24 (19.5%) for colorectal metastasis, and 28 (22.8%) were for other benign and malignant tumors. Median operative time was 239 (range 89-526) minutes. Mean estimated blood loss was 192 (range 0-1800) mL. The median length of stay (LOS) overall was 2 (range 0-9) days. From 2017 to 2019, the mean LOS was 1.2 days, compared to a mean LOS of 3.3 days from 2012 to 2016. More cases were performed as same-day surgery from 2017 onward; 19 patients (33.9%) had same-day surgery from 2017 to 2019, in comparison to only 1 patient (1.5%) in the period of 2012-2016 ( < .0001). Overall, 28 patients (22.8%) experienced postoperative morbidity; major postoperative morbidity occurred in 4 patients (3.3%). The 90-day mortality was .8%, and the 30-day readmission rate was 5.7%. In conclusion, LLR can be performed safely to treat liver tumors, and LOS decreased over time. Although overall morbidity is moderate, serious morbidity is low, as was the readmission rate. Laparoscopic wedge resection may be a feasible option as an outpatient procedure in select patients.
在过去的 20 年中，腹腔镜肝切除术（LLR）的应用显著增加。本研究旨在分析单所三级护理医院与 LLR 相关的结果。研究期间，共有 123 名患者由同一位外科医生行 LLR 治疗，这些患者患有良性或恶性肿瘤。其中 52%为男性，中位年龄为 61（24-90）岁。5 例（4.1%）患者计划外转为开放性切除。95 例（77.2%）行楔形切除术或单段切除术，28 例（22.8%）行 2+肝段切除术。71 例（57.7%）为肝细胞癌（HCC），24 例（19.5%）为结直肠癌转移，28 例（22.8%）为其他良性和恶性肿瘤。中位手术时间为 239（89-526）分钟。平均估计出血量为 192（0-1800）毫升。总体而言，中位住院时间（LOS）为 2（0-9）天。从 2017 年到 2019 年，平均 LOS 为 1.2 天，而 2012 年至 2016 年的平均 LOS 为 3.3 天。从 2017 年开始，更多的病例被作为日间手术进行；2017 年至 2019 年有 19 例（33.9%）患者为日间手术，而 2012 年至 2016 年期间仅 1 例（1.5%）患者为日间手术（<.0001）。总的来说，28 例（22.8%）患者术后发生并发症；4 例（3.3%）患者发生严重术后并发症。90 天死亡率为 0.8%，30 天再入院率为 5.7%。总之，腹腔镜肝切除术可以安全地治疗肝脏肿瘤，并且随着时间的推移，住院时间有所减少。尽管总体发病率中等，但严重发病率较低，再入院率也较低。腹腔镜楔形切除术可能是一种可行的选择，适用于某些患者的门诊手术。
