Mu Chunyang, Chen Chuwen, Wan Jianghong, Chen Guoxin, Hu Jing, Wen Tianfu
Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Outpatient, West China Hospital, Sichuan University, Chengdu 610041, China.
J Clin Med. 2023 Apr 17;12(8):2904. doi: 10.3390/jcm12082904.
How to obtain a donor liver remains an open issue, especially in the choice of minimally invasive donors right hepatectomy versus open donors right hepatectomy (MIDRH versus ODRH). We conducted a meta-analysis to clarify this question.
A meta-analysis was performed in PubMed, Web of Science, EMBASE, Cochrane Central Register, and ClinicalTrials.gov databases. Baseline characteristics and perioperative outcomes were analyzed.
A total of 24 retrospective studies were identified. For MIDRH vs. ODRH, the operative time was longer in the MIDRH group (mean difference [MD] = 30.77 min; = 0.006). MIDRH resulted in significantly less intraoperative blood loss (MD = -57.86 mL; < 0.00001), shorter length of stay (MD = -1.22 days; < 0.00001), lower pulmonary (OR = 0.55; = 0.002) and wound complications (OR = 0.45; = 0.0007), lower overall complications (OR = 0.79; = 0.02), and less self-infused morphine consumption (MD = -0.06 days; 95% CI, -1.16 to -0.05; = 0.03). In the subgroup analysis, similar results were observed in pure laparoscopic donor right hepatectomy (PLDRH) and the propensity score matching group. In addition, there were no significant differences in post-operation liver injury, bile duct complications, Clavien-Dindo ≥ 3 III, readmission, reoperation, and postoperative transfusion between the MIDRH and ODRH groups.
We concluded that MIDRH is a safe and feasible alternative to ODRH for living donators, especially in the PLDRH group.
如何获取供体肝脏仍是一个悬而未决的问题，尤其是在选择微创供体右半肝切除术与开放供体右半肝切除术（微创供体右半肝切除术与开放供体右半肝切除术）方面。我们进行了一项荟萃分析以阐明这个问题。
在PubMed、Web of Science、EMBASE、Cochrane Central Register和ClinicalTrials.gov数据库中进行了荟萃分析。分析了基线特征和围手术期结果。
共纳入24项回顾性研究。对于微创供体右半肝切除术与开放供体右半肝切除术，微创供体右半肝切除术组的手术时间更长（平均差[MD]=30.77分钟；P=0.006）。微创供体右半肝切除术导致术中出血量显著减少（MD=-57.86毫升；P<0.00001），住院时间缩短（MD=-1.22天；P<0.00001），肺部并发症（OR=0.55；P=0.002）和伤口并发症（OR=0.45；P=0.0007）发生率更低，总体并发症（OR=0.79；P=0.02）发生率更低，且自我注射吗啡的消耗量更少（MD=-0.06天；95%CI，-1.16至-0.05；P=0.03）。在亚组分析中，在单纯腹腔镜供体右半肝切除术（PLDRH）和倾向评分匹配组中观察到了类似的结果。此外，微创供体右半肝切除术组和开放供体右半肝切除术组在术后肝损伤、胆管并发症、Clavien-Dindo≥3级、再次入院、再次手术和术后输血方面无显著差异。
我们得出结论，对于活体供体而言，微创供体右半肝切除术是开放供体右半肝切除术的一种安全可行的替代方法，尤其是在单纯腹腔镜供体右半肝切除术组。
