Barba Giuliano La, Solaini Leonardo, Radi Giorgia, Mirarchi Maria Teresa, D'Acapito Fabrizio, Gardini Andrea, Cucchetti Alessandro, Ercolani Giorgio
Department of General Surgery, Morgagni-Pierantoni Hospital, Forli, Italy.
Department of General Surgery, Morgagni-Pierantoni Hospital, Forli; Department of Medical and Surgical Sciences, DIMEC; Alma Mater Studiorum, University of Bologna, Italy.
J Minim Access Surg. 2022 Jan-Mar;18(1):51-57. doi: 10.4103/jmas.JMAS_310_20.
In the last decades, there has been an exponential diffusion of minimally invasive liver surgery (MILS) worldwide. The aim of this study was to evaluate our initial experience of 100 patients undergoing MILS resection comparing their outcomes with the standard open procedures.
One hundred consecutive MILS from 2016 to 2019 were included. Clinicopathological data were reviewed to evaluate outcomes. Standard open resections were used as the control group and compared exploiting propensity score matching.
In total, 290 patients were included. The rate of MILS has been constantly increasing throughout years, representing the 48% in 2019. Of 100 (34.5%) MILS patients, 85 could be matched. After matching, the MILS conversion rate was 5.8% (n = 5). The post-operative complication rates were higher in the open group (45.9% vs. 31.8%, P = 0.004). Post-operative blood transfusions were less common in the MILS group (4.7% vs. 16.5%, P = 0.021). Biliary leak occurred in 2 (2.4) MILS versus 13 (15.3) open. The median comprehensive complication index was higher in the open group (8.7 [0-28.6] vs. 0 [0-10.4], P = 0.0009). The post-operative length of hospital stay was shorter after MILS (median 6 [5-8] vs 8 [7-13] days, P < 0.0001).
The rate of MILS has been significantly increasing throughout the years. The benefits of MILS over the traditional open approach were confirmed. The main advantages include lower rates of post-operative complications, blood transfusions, bile leaks and a significantly decreased hospital stay.
在过去几十年中，微创肝脏手术（MILS）在全球范围内呈指数级扩散。本研究的目的是评估我们对100例行MILS切除术患者的初步经验，并将其结果与标准开放手术进行比较。
纳入2016年至2019年连续的100例MILS病例。回顾临床病理数据以评估结果。将标准开放切除术用作对照组，并采用倾向评分匹配进行比较。
共纳入290例患者。多年来MILS的比例一直在持续上升，2019年占48%。100例（34.5%）MILS患者中，85例可进行匹配。匹配后，MILS转换率为5.8%（n = 5）。开放组术后并发症发生率更高（45.9%对31.8%，P = 0.004）。MILS组术后输血较少见（4.7%对16.5%，P = 0.021）。MILS组发生胆漏2例（2.4%），开放组发生13例（15.3%）。开放组的综合并发症指数中位数更高（8.7 [0 - 28.6]对0 [0 - 10.4]，P = 0.0009）。MILS术后住院时间更短（中位数6 [5 - 8]天对8 [7 - 13]天，P < 0.0001）。
多年来MILS的比例显著增加。证实了MILS相对于传统开放手术方法的优势。主要优点包括术后并发症、输血、胆漏发生率较低以及住院时间显著缩短。
