Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu City, Shizuoka, 431-3192, Japan.
Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu City, Shizuoka, 431-3192, Japan.
Surg Today. 2024 Oct;54(10):1227-1237. doi: 10.1007/s00595-024-02834-w. Epub 2024 Apr 12.
To compare changes in liver enzyme levels on postoperative day 1 between patients with and without silicone disc (SD) use during liver retraction in laparoscopic gastrectomy for gastric cancer and laparoscopic gastric mobilization for esophageal cancer.
This prospective randomized controlled phase II trial was conducted between June 30, 2020, and November 30, 2022, to investigate the benefits of using an SD with a Nathanson liver retractor (NLR) compared with those using an NLR in laparoscopic gastrectomy and gastric mobilization. The primary endpoint was the change in transaminase level on postoperative day 1.
A total of 86 patients received randomized assignments and were included in the analysis, with 44 assigned to the SD (-) group and 42 to the SD (+) group. On postoperative day 1, the SD (+) group showed a significantly lower increase in the aspartate aminotransferase levels than the SD (-) group (SD [+], 94.4% vs. SD [-], 179.8%; p = 0.012). Similarly, the SD (+) group showed a significantly lower increase in alanine aminotransferase levels than the SD (-) group (SD [+], 71.6% vs. SD [-], 201.5%; p = 0.014).
In laparoscopic gastrectomy, the use of an SD combined with an NLR appears to mitigate postoperative liver dysfunction.
比较在腹腔镜胃癌根治术肝游离时使用和不使用硅树脂盘（SD）与在腹腔镜食管癌根治术胃游离时使用和不使用 Nathanson 肝拉钩（NLR）对术后第 1 天肝酶水平变化的影响。
这是一项前瞻性随机对照 II 期试验，于 2020 年 6 月 30 日至 2022 年 11 月 30 日进行，旨在研究在腹腔镜胃癌根治术和胃游离术中使用 SD 联合 NLR 相对于单独使用 NLR 的优势。主要终点是术后第 1 天转氨酶水平的变化。
共有 86 例患者接受了随机分组，并纳入了分析，其中 44 例被分配到 SD（-）组，42 例被分配到 SD（+）组。术后第 1 天，SD（+）组的天门冬氨酸转氨酶升高幅度明显低于 SD（-）组（SD[+]，94.4% vs. SD[-]，179.8%；p=0.012）。同样，SD（+）组的丙氨酸转氨酶升高幅度也明显低于 SD（-）组（SD[+]，71.6% vs. SD[-]，201.5%；p=0.014）。
在腹腔镜胃癌根治术中，使用 SD 联合 NLR 似乎可以减轻术后肝功能障碍。
