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供体体重指数超过30并非单纯腹腔镜供体右半肝切除术的障碍。

Donor body mass index over 30 is no barrier for pure laparoscopic donor right hepatectomy.

作者信息

Hong Suk Kyun, Kim Minseob, Kim Youngjin, Kim Jae-Yoon, Lee Jaewon, Kim Jiyoung, Hong Su Young, Lee Jeong-Moo, Choi YoungRok, Yi Nam-Joon, Lee Kwang-Woong, Suh Kyung-Suk

机构信息

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

出版信息

Ann Hepatobiliary Pancreat Surg. 2024 Aug 31;28(3):337-343. doi: 10.14701/ahbps.24-020. Epub 2024 Apr 3.

DOI:10.14701/ahbps.24-020
PMID:38566519
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11341885/
Abstract

BACKGROUNDS/AIMS: Challenges arise when translating pure laparoscopic donor right hepatectomy (PLDRH) results from Asian to Western donors, due to differences in body mass index (BMI). This study compares the outcomes of PLDRH and conventional open donor right hepatectomy (CDRH) in donors with BMI over 30.

METHODS

Medical records of live liver donors (BMI > 30) undergoing right hepatectomy (2010-2021) were compared: 25 PLDRH cases vs. 19 CDRH cases. Donor and recipient demographics, operative details, and outcomes were analyzed.

RESULTS

PLDRH and CDRH had similar donor and recipient characteristics. PLDRH had longer liver removal and warm ischemic times, but a shorter post-liver removal duration than CDRH. Donor complication rates were comparable, with the highest complication being grade IIIa in PLDRH, necessitating needle aspiration for biloma on postoperative day 11. Fortunately, this donor fully recovered without additional treatment. No complications exceeding Clavien-Dindo grade IIIa occurred in either group. Recipient outcomes between the groups were similar.

CONCLUSIONS

This study supports PLDRH as a viable option for donors with BMI over 30, challenging the notion that high BMI should deter considering PLDRH. The findings provide valuable insights into the safety and feasibility of PLDRH, encouraging further exploration of this technique in diverse donor populations.

摘要

背景/目的：由于体重指数（BMI）存在差异，将单纯腹腔镜供体右半肝切除术（PLDRH）在亚洲供体中的结果应用于西方供体时会面临挑战。本研究比较了BMI超过30的供体中PLDRH与传统开放性供体右半肝切除术（CDRH）的结果。

方法

比较了2010年至2021年期间接受右半肝切除术的活体肝供体（BMI>30）的病历：25例PLDRH病例与19例CDRH病例。分析了供体和受体的人口统计学特征、手术细节及结果。

结果

PLDRH组和CDRH组的供体和受体特征相似。PLDRH组的肝脏切除时间和热缺血时间更长，但肝切除术后持续时间比CDRH组短。供体并发症发生率相当，PLDRH组最高并发症为Ⅲa级，术后第11天因胆汁瘤需进行穿刺抽吸。幸运的是，该供体未经额外治疗完全康复。两组均未发生超过Clavien-DindoⅢa级的并发症。两组受体的结果相似。

结论

本研究支持PLDRH作为BMI超过30的供体的一种可行选择，挑战了高BMI应阻碍考虑PLDRH的观念。这些发现为PLDRH的安全性和可行性提供了有价值的见解，鼓励在不同供体人群中进一步探索该技术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8f88/11341885/3d74b46e5540/ahbps-28-3-337-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8f88/11341885/3d74b46e5540/ahbps-28-3-337-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8f88/11341885/3d74b46e5540/ahbps-28-3-337-f1.jpg

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本文引用的文献

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Pure laparoscopic donor hepatectomy: Experience of 556 cases at Seoul National University Hospital.单纯腹腔镜供肝切除术：首尔国立大学医院 556 例经验。
Am J Transplant. 2024 Feb;24(2):222-238. doi: 10.1016/j.ajt.2023.06.007. Epub 2023 Jun 14.
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OPTN/SRTR 2021 Annual Data Report: Liver.OPTN/SRTR 2021 年度数据报告：肝脏。
Am J Transplant. 2023 Feb;23(2 Suppl 1):S178-S263. doi: 10.1016/j.ajt.2023.02.006.
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Donor BMI and Post-living Donor Liver Transplantation Outcomes: A Preliminary Report.供体体重指数与活体供肝肝移植结局：初步报告。
Transplant Direct. 2023 Jan 12;9(2):e1431. doi: 10.1097/TXD.0000000000001431. eCollection 2023 Feb.
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Complete transition from open surgery to laparoscopy: 8-year experience with more than 500 laparoscopic living donor hepatectomies.从开放性手术完全过渡到腹腔镜手术：500 多例腹腔镜活体供肝切除术的 8 年经验。
Liver Transpl. 2022 Jul;28(7):1158-1172. doi: 10.1002/lt.26429. Epub 2022 Jun 5.
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Demarcating the Exact Midplane of the Liver Using Indocyanine Green Near-Infrared Fluorescence Imaging During Laparoscopic Donor Hepatectomy.腹腔镜供肝切除术中使用吲哚菁绿近红外荧光成像技术标定肝脏的精确中平面。
Liver Transpl. 2021 Jun;27(6):830-839. doi: 10.1002/lt.26019.
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Expert Consensus Guidelines on Minimally Invasive Donor Hepatectomy for Living Donor Liver Transplantation From Innovation to Implementation: A Joint Initiative From the International Laparoscopic Liver Society (ILLS) and the Asian-Pacific Hepato-Pancreato-Biliary Association (A-PHPBA).微创供肝切取用于活体肝移植的专家共识指南：从创新到实施：国际腹腔镜肝脏学会（ILLS）和亚太肝脏病学、胆胰学和肝脏移植学会（A-PHPBA）的联合倡议。
Ann Surg. 2021 Jan 1;273(1):96-108. doi: 10.1097/SLA.0000000000004475.
7
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