腹腔镜肝切除术是否能使 COPD 患者获益？一项倾向评分分析。

Does laparoscopic hepatectomy offer benefits for patients with COPD? A propensity score analysis.

机构信息

Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.

出版信息

HPB (Oxford). 2021 Nov;23(11):1708-1715. doi: 10.1016/j.hpb.2021.04.007. Epub 2021 Apr 27.

DOI:10.1016/j.hpb.2021.04.007

PMID:33975796

Abstract

BACKGROUND

To date, it remains unclear whether laparoscopic hepatectomy (LH) is safe and feasible for patients with chronic obstructive pulmonary disease (COPD). Thus, we compared the perioperative outcomes of LH versus open hepatectomy (OH) in this special cohort of patients.

METHODS

Between February 2014 and October 2020, 162 patients who underwent hepatectomy met the inclusion and exclusion criteria of this study. Perioperative data were compared between the two groups by propensity score matching (PSM) analysis.

RESULTS

After PSM, 55 patients with well-balanced baseline data were included in each group. Intraoperative blood loss, overall postoperative complications, and postoperative pulmonary complications (PPCs) were significantly lower in the LH group than in the OH group (P < 0.001, P = 0.047, and P = 0.020 after PSM, respectively). However, major complications, early readmission, and early mortality were comparable between the two groups. According to multivariate analysis, high stage of COPD, preoperative tobacco use, and long operative time were independent risk factors for PPCs, whereas treatment with LH was a protective factor.

CONCLUSION

LH is safe and feasible for selected patients with COPD when performed by experienced surgeons, and it has superior perioperative outcomes (especially regarding PPCs) when compared to OH.

摘要

背景

迄今为止，对于合并慢性阻塞性肺疾病（COPD）的患者，腹腔镜肝切除术（LH）是否安全、可行仍不清楚。因此，我们比较了这一特殊患者群体中行 LH 与开腹肝切除术（OH）的围手术期结局。

方法

2014 年 2 月至 2020 年 10 月，符合本研究纳入和排除标准的 162 例行肝切除术的患者纳入研究。通过倾向评分匹配（PSM）分析比较两组的围手术期数据。

结果

PSM 后，每组纳入 55 例基线数据均衡的患者。LH 组的术中出血量、总术后并发症和术后肺部并发症（PPCs）显著低于 OH 组（PSM 后分别为 P<0.001、P=0.047 和 P=0.020）。然而，两组的主要并发症、早期再入院和早期死亡率相当。多因素分析显示，COPD 高分期、术前吸烟和手术时间长是 PPCs 的独立危险因素，而 LH 治疗是保护性因素。