对于病变紧邻大血管的患者，机器人肝脏切除术是否可行？一项倾向评分匹配分析。
Is robotic liver resection feasible in patients with lesions in close proximity to major vessels? A propensity score matching analysis.
作者信息
Muttillo Edoardo M, Chiarella Leonardo L, Ratti Francesca, Magistri Paolo, Belli Andrea, Berardi Giammauro, Ettorre Giuseppe M, Ceccarelli Graziano, Izzo Francesco, Spampinato Marcello G, Angelis Nicola De, Pessaux Patrick, Piardi Tullio, Di Benedetto Fabrizio, Aldrighetti Luca, Memeo Riccardo
机构信息
Service de Chirurgie Hépato-Bilio-Pancréatique et Tumeur Endocrinienne CHU Edouard Herriot, Lyon, France; Division of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy; Department of Medical Surgical Science and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, 00198 Rome, Italy.
Department of Hepato-Pancreatc-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva Delle Fonti, Department of Medicine and Surgery, LUM University, Casamassima, Bari, Italy.
出版信息
HPB (Oxford). 2025 Jan;27(1):21-28. doi: 10.1016/j.hpb.2024.09.010. Epub 2024 Sep 29.
INTRODUCTION
Robotic surgery is widely diffused in the surgical field and is becoming increasingly prevalent, however several aspects need more detailed assessment. One of them concerns the role of robotic liver surgery for lesions in contact with major vascular (CMV) pedicles. The aim of our study is to evaluate and compare intra and post operative outcomes in patients undergoing robotic liver resections between lesions in contact or free from major vessels.
METHODS
A multicentric retrospective study was performed including 1030 patients who underwent robotic liver resection. Patients were divided into two groups according to vascular contact. Intra and post-operative outcomes were compared between the groups before and after Propensity Score Matching.
RESULTS
After propensity score matching 889 patients were included in the study. Among these lesions, 595 were not in contact with major vessels (NCMV) and 294 were in contact with major vessels (CMV). Use of Pringle Manoeuvre was more associated with CMV resections (49.8 % vs 31.2 %, p = 0,0001). No differences in terms of operative time, conversion rate, morbidity and type of complications were observed after PSM.
CONCLUSION
The presents study shows how robotic surgery is a valid and safe technique also for resection of tumors close to vascular pedicles.
引言
机器人手术在外科领域已广泛普及且日益盛行，然而，有几个方面需要更详细的评估。其中之一涉及机器人肝脏手术对与主要血管（CMV）蒂接触的病变的作用。我们研究的目的是评估和比较接受机器人肝脏切除术的患者中，病变与主要血管接触或不接触的患者的术中及术后结果。
方法
进行了一项多中心回顾性研究，纳入1030例行机器人肝脏切除术的患者。根据血管接触情况将患者分为两组。在倾向得分匹配前后，对两组的术中及术后结果进行比较。
结果
倾向得分匹配后，889例患者纳入研究。在这些病变中，595例未与主要血管接触（NCMV），294例与主要血管接触（CMV）。Pringle手法的使用与CMV切除更相关（49.8%对31.2%，p = 0.0001）。倾向得分匹配后，在手术时间、转化率、发病率和并发症类型方面未观察到差异。
结论
本研究表明，机器人手术对于切除靠近血管蒂的肿瘤也是一种有效且安全的技术。
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