Fuji Tomokazu, Kojima Toru, Kajioka Hiroki, Sakamoto Misaki, Oka Ryoya, Katayama Tetsuya, Narahara Yuki, Niguma Takefumi
Department of Surgery, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-ku, Okayama, 700-8511, Japan.
Surg Endosc. 2023 Feb;37(2):1262-1273. doi: 10.1007/s00464-022-09664-2. Epub 2022 Sep 29.
Liver fibrosis or cirrhosis frequently makes parenchymal transection more difficult, but the difficulty score of laparoscopic liver resection (LLR), including the IWATE criteria, does not include a factor related to liver fibrosis. Therefore, this study aimed to evaluate M2BPGi as a predictor of the difficulty of parenchymal transection and the incidence of postoperative complications in LLR.
Data from 54 patients who underwent laparoscopic partial liver resection (LLR-P) and 24 patients who underwent laparoscopic anatomical liver resection between 2017 and 2019 in our institution were retrospectively analyzed. All cases were classified according to M2BPGi scores, and reserve liver function, intraoperative blood loss, and postoperative complications were compared among these groups.
Sixteen cases (29.6%) were M2BPGi negative (cut-off index < 1.0), 25 cases (46.3%) were 1+ (1.0 ≤ cut-off index < 3.0), and 13 cases (24.1%) were 2+ (cut-off index ≥ 3.0). M2BPGi-positive cases had significantly worse hepatic reserve function (K-ICG: 0.16 vs 0.14 vs 0.08, p < 0.0001). Intraoperative bleeding was significantly greater in M2BPGi-positive cases [50 ml vs 150 ml vs 200 ml, M2BPGi (-) or (1+) vs M2BPGi (2+), p = 0.045]. Postoperative complications (Clavien-Dindo ≥ II) were significantly more frequent in M2BPGi-positive cases [0% vs 4% vs 33%, M2BPGi (-) or (1+) vs M2BPGi (2+), p = 0.001].
M2BPGi could predict surgical difficulty and complications in LLR-P. In particular, it might be better not to select M2BPGi (2+) cases as teaching cases because of the massive bleeding during parenchymal transection.
肝纤维化或肝硬化常常使实质离断更加困难，但包括岩手标准在内的腹腔镜肝切除术（LLR）难度评分并未纳入与肝纤维化相关的因素。因此，本研究旨在评估M2BPGi作为LLR实质离断难度及术后并发症发生率预测指标的价值。
回顾性分析2017年至2019年在本机构接受腹腔镜肝部分切除术（LLR-P）的54例患者及接受腹腔镜解剖性肝切除术的24例患者的数据。所有病例根据M2BPGi评分进行分类，并比较这些组之间的残余肝功能、术中出血量及术后并发症情况。
16例（29.6%）为M2BPGi阴性（截断指数＜1.0），25例（46.3%）为1+（1.0≤截断指数＜3.0），13例（24.1%）为2+（截断指数≥3.0）。M2BPGi阳性病例的肝脏储备功能明显更差（吲哚氰绿滞留率：0.16对0.14对0.08，p＜0.0001）。M2BPGi阳性病例的术中出血量明显更多[50ml对150ml对200ml，M2BPGi（-）或（1+）对M2BPGi（2+），p = 0.045]。M2BPGi阳性病例术后并发症（Clavien-Dindo≥Ⅱ级）明显更常见[0%对4%对33%，M2BPGi（-）或（1+）对M2BPGi（2+），p = 0.001]。
M2BPGi可预测LLR-P的手术难度及并发症。特别是，由于实质离断时大量出血，可能最好不要选择M2BPGi（2+）病例作为教学病例。
