Bang Yu Jeong, Jun Joo Hyun, Gwak Mi Sook, Ko Justin Sangwook, Kim Jong Man, Choi Gyu Seong, Joh Jae Won, Kim Gaab Soo
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2021 Apr;100(4):235-245. doi: 10.4174/astr.2021.100.4.235. Epub 2021 Mar 30.
To lessen the physical, cosmetic, and psychological burden of donors, purely laparoscopic donor hepatectomy (PLDH) has been proposed as an ideal method for living donors. Our study aimed to prospectively compare the effect of PLDH and 2 other types of open living donor hepatectomy (OLDH) on postoperative pain and recovery.
Sixty donors scheduled to undergo donor hepatectomy between March 2015 and November 2017 were included. Donors were divided into 3 groups by surgical technique: OLDH with a subcostal incision (n = 20), group S; OLDH with an upper midline incision (n = 20), group M; and PLDH (n = 20), group L. The primary outcomes were postoperative pain and analgesic requirement during postoperative day (POD) 3. Other variables regarding postoperative recovery were also analyzed.
Although pain relief during POD 3, assessed by visual analog scale (VAS) score and analgesic requirement, was similar among the 3 groups, group L showed lower VAS scores and opioid requirements than group M. Moreover, group L was associated with a rapid postoperative recovery evidenced by the shorter hospital length of stay and more frequent return to normal activity on POD 30.
This pilot study failed to verify the hypothesis that PLDH reduces postoperative pain. PLDH did not reduce postoperative pain but showed faster recovery than OLDH.
为减轻供者的生理、美容和心理负担，单纯腹腔镜供肝切除术（PLDH）已被提议作为活体供者的理想术式。我们的研究旨在前瞻性比较PLDH与其他两种开放式活体供肝切除术（OLDH）对术后疼痛及恢复情况的影响。
纳入2015年3月至2017年11月期间计划接受供肝切除术的60例供者。根据手术技术将供者分为3组：经肋下切口的OLDH（n = 20），S组；经上腹部正中切口的OLDH（n = 20），M组；以及PLDH（n = 20），L组。主要观察指标为术后第3天的术后疼痛及镇痛需求。还分析了与术后恢复相关的其他变量。
尽管通过视觉模拟量表（VAS）评分和镇痛需求评估，3组在术后第3天的疼痛缓解情况相似，但L组的VAS评分和阿片类药物需求量低于M组。此外，L组术后恢复较快，表现为住院时间较短，且在术后第30天更频繁地恢复正常活动。
这项初步研究未能证实PLDH可减轻术后疼痛这一假设。PLDH虽未减轻术后疼痛，但比OLDH恢复得更快。
