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腹腔镜与开放手术行右前叶肝切除术的安全性及可行性对比分析

Comparative analysis of the safety and feasibility of laparoscopic and open approaches for right anterior sectionectomy.

作者信息

Li Wen, Zeng Haitao, Huang Yong

机构信息

Department of General Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.

出版信息

Sci Rep. 2024 Dec 4;14(1):30185. doi: 10.1038/s41598-024-80148-0.

DOI:10.1038/s41598-024-80148-0
PMID:39632910
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11618377/
Abstract

Laparoscopic hepatectomy has minimally invasive advantages, but reports on laparoscopic right anterior sectionectomy (LRAS) are rare. Herein, we try to explore the benefits and drawbacks of LRAS by comparing it with open right anterior sectionectomy (ORAS). Between January 2015 and September 2023, 39 patients who underwent LRAS (n = 18) or ORAS (n = 21) were enrolled in the study. The patients' characteristics, intraoperative details, and postoperative outcomes were compared between the two groups. No significant differences in the preoperative data were observed between the two groups. The LRAS group had significantly lesser blood loss (P = 0.019), a shorter hospital stay (P = 0.045), and a higher rate of bile leak (P = 0.039) than the ORAS group. There was no significant difference in the operative time (P = 0.156), transfusion rate (P = 0.385), hospital expenses (P = 0.511), rate of other complications, postoperative white blood cell count, and alanine aminotransferase and aspartate aminotransferase levels between the two groups (P > 0.05). Beside, there was no significant difference in disease-free survival (P = 0.351) or overall survival (P = 0.613) in patients with hepatocellular carcinoma between the two groups. LRAS is a safe and feasible surgical procedure. It may be preferred for lesions in the right anterior lobe of the liver.

摘要

腹腔镜肝切除术具有微创优势,但关于腹腔镜右前叶切除术(LRAS)的报道较少。在此,我们试图通过将LRAS与开腹右前叶切除术(ORAS)进行比较,探讨LRAS的利弊。2015年1月至2023年9月,39例行LRAS(n = 18)或ORAS(n = 21)的患者纳入本研究。比较两组患者的特征、术中细节及术后结果。两组术前数据无显著差异。与ORAS组相比,LRAS组术中出血量显著更少(P = 0.019),住院时间更短(P = 0.045),胆漏发生率更高(P = 0.039)。两组手术时间(P = 0.156)、输血率(P = 0.385)、住院费用(P = 0.511)、其他并发症发生率、术后白细胞计数以及丙氨酸氨基转移酶和天冬氨酸氨基转移酶水平无显著差异(P > 0.05)。此外,两组肝细胞癌患者的无病生存期(P = 0.351)或总生存期(P = 0.613)无显著差异。LRAS是一种安全可行的手术方法。对于肝右前叶病变可能更适用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95d2/11618377/a296664cbbe3/41598_2024_80148_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95d2/11618377/7d417a6c4cef/41598_2024_80148_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95d2/11618377/e700c9a6898e/41598_2024_80148_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95d2/11618377/db43f4f5d82c/41598_2024_80148_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95d2/11618377/a296664cbbe3/41598_2024_80148_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95d2/11618377/7d417a6c4cef/41598_2024_80148_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95d2/11618377/e700c9a6898e/41598_2024_80148_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95d2/11618377/db43f4f5d82c/41598_2024_80148_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95d2/11618377/a296664cbbe3/41598_2024_80148_Fig4_HTML.jpg

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本文引用的文献

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Combination of a Glissonean Approach and Indocyanine Green Fluorescence Imaging to Perform a Laparoscopic Right Anterior Sectionectomy.Glissonean 入路联合吲哚菁绿荧光成像在腹腔镜右前段肝切除术的应用。
Ann Surg Oncol. 2024 Jun;31(6):4030. doi: 10.1245/s10434-024-15151-w. Epub 2024 Mar 20.
2
Augmented Reality Navigation System and Indocyanine Green Fluorescence Imaging Make Laparoscopic Right Anterior Sectionectomy More Precisely and Safely.增强现实导航系统和吲哚菁绿荧光成像使腹腔镜右前节切除术更精确、更安全。
J Gastrointest Surg. 2023 Aug;27(8):1751-1752. doi: 10.1007/s11605-023-05680-2. Epub 2023 Apr 24.
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Indocyanine green fluorescence-guided laparoscopic hepatectomy versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: A single-center propensity score matching study.
吲哚菁绿荧光引导下腹腔镜肝切除术与传统腹腔镜肝切除术治疗肝细胞癌的单中心倾向评分匹配研究
Front Oncol. 2022 Jul 19;12:930065. doi: 10.3389/fonc.2022.930065. eCollection 2022.
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Minimally invasive versus open right anterior sectionectomy and central hepatectomy for central liver malignancies: a propensity-score-matched analysis.微创与开放右前叶切除术及中央肝切除术治疗中央型肝脏恶性肿瘤:一项倾向评分匹配分析
ANZ J Surg. 2021 Apr;91(4):E174-E182. doi: 10.1111/ans.16719. Epub 2021 Mar 15.
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Safety and feasibility for laparoscopic versus open caudate lobe resection: a meta-analysis.腹腔镜与开腹尾状叶切除术的安全性和可行性:荟萃分析。
Langenbecks Arch Surg. 2021 Aug;406(5):1307-1316. doi: 10.1007/s00423-020-02055-y. Epub 2021 Jan 6.
6
Comparative analysis of the safety and feasibility of laparoscopic versus open caudate lobe resection.腹腔镜与开腹尾状叶切除术的安全性和可行性比较分析。
Langenbecks Arch Surg. 2020 Sep;405(6):737-744. doi: 10.1007/s00423-020-01928-6. Epub 2020 Jul 9.
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Hepatol Int. 2020 Jul;14(4):437-453. doi: 10.1007/s12072-020-10052-y. Epub 2020 Jul 7.
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