Park Jae Hyun, Suh Sanggyun, Hong Suk Kyun, Lee Sola, Hong Su Young, Choi YoungRok, Yi Nam-Joon, Lee Kwang-Woong, Suh Kyung-Suk
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2022 Jul;103(1):40-46. doi: 10.4174/astr.2022.103.1.40. Epub 2022 Jul 7.
Analyses on pure laparoscopy in donor hepatectomies, including the middle hepatic vein (MHV), are still scarce. This study aimed to compare the outcomes of donor right hepatectomy, including the MHV, when performed laparoscopically with conventional open surgery.
Data from living donors who underwent donor right hepatectomy between January 2012 and December 2020 were retrospectively analyzed. The intraoperative and postoperative complication rates of the pure laparoscopic donor right hepatectomy (PLDRH) with MHV inclusion (PLDRHM) group were compared with the conventional open donor right hepatectomy with MHV inclusion (CDRHM) group and the PLDRH without MHV inclusion [PLDRHM(-)] group.
Compared to the CDRHM group, the PLDRHM group had a longer bench time (P < 0.001) and higher Δ%, calculated as [(preoperative value - postoperative value)/preoperative value] × 100, of AST (P < 0.001), ALT (P < 0.001), and total bilirubin (P = 0.023), but shorter hospital stay (P = 0.004) and a lower rate of complications (P = 0.005). Compared to the PLDRHM(-) group, the PLDRHM group had fewer male donors (P < 0.001) and a lower body mass index (P < 0.001), estimated total liver volume (P < 0.001), and real graft weight (P < 0.001). Results of laboratory changes, hospital stays, and complication rates were similar between the 2 groups.
PLDRH with the inclusion of the MHV in selected donors and recipients is feasible and safe when performed by surgeons experienced in laparoscopic surgery, with favorable complication rates compared to CDRHM and PLDRHM(-).
关于包括肝中静脉（MHV）在内的单纯腹腔镜供肝切除术的分析仍然较少。本研究旨在比较包括MHV的腹腔镜供体右肝切除术与传统开放手术的手术效果。
回顾性分析2012年1月至2020年12月期间接受供体右肝切除术的活体供体的数据。将包含MHV的单纯腹腔镜供体右肝切除术（PLDRHM）组的术中和术后并发症发生率与包含MHV的传统开放供体右肝切除术（CDRHM）组以及不包含MHV的PLDRH [PLDRHM(-)]组进行比较。
与CDRHM组相比，PLDRHM组的冷缺血时间更长（P < 0.001），AST、ALT和总胆红素的Δ%更高（Δ%计算为[(术前值 - 术后值)/术前值]×100），分别为AST（P < 0.001）、ALT（P < 0.001）和总胆红素（P = 0.023），但住院时间更短（P = 0.004），并发症发生率更低（P = 0.005）。与PLDRHM(-)组相比，PLDRHM组男性供体更少（P < 0.001），体重指数更低（P < 0.001），估计全肝体积更低（P < 0.001），实际移植肝重量更低（P < 0.001）。两组之间实验室指标变化、住院时间和并发症发生率的结果相似。
对于有经验的腹腔镜手术外科医生而言，在选定的供体和受体中进行包含MHV的PLDRH是可行且安全的，与CDRHM和PLDRHM(-)相比，并发症发生率较低。
