Serednicki Wojciech A, Grochowska Anna, Hołówko Wacław, Dąbrowska Anna, Janik Natalia, Pędziwiatr Michał
Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.
Department of Radiology, Jagiellonian University Medical College, Krakow, Poland.
BMC Surg. 2025 Jul 22;25(1):313. doi: 10.1186/s12893-025-03051-z.
Laparoscopic liver resection is a feasible and fast-disseminating, yet demanding technique that requires careful preoperative preparation. Due to its varying difficulty, many scales were developed to evaluate possible intraoperative difficulties and to select cases properly, especially during the learning curve. Our aim was to seek additional radiological parameters, such as liver venous system diameters, that may be useful in assessing possible intraoperative difficulties and predicting postoperative outcomes.
A retrospective study included 85 patients who underwent laparoscopic liver resection with previous computed tomography or magnetic resonance. Patients were divided into 3 groups of varying difficulty according to the Institute Mutualiste Montsouris (IMM) scale. Using syngo.via radiological system, the diameters of portal vessels and inferior vena cava were measured. Statistical analysis was performed to assess the correlation between measured radiological parameters and perioperative outcomes.
Statistical analysis showed no correlation between portal and splenic vein diameter and perioperative outcomes in all patient population and in each of the IMM groups. Superior mesenteric vein (SMV) diameter correlated positively with intraoperative complication rate, but only in the IMM 2 group. Intraoperative Oslo complication rate was higher in < 10 mm splenic vein diameter group and the Clavien-Dindo complication rate was higher in < 13 mm SMV population, but only in the IMM 2 group.
Our study presents that portal system veins and inferior vena cava (IVC) diameter have low relevance to perioperative outcomes and don't seem to be a good predictor of intraoperative blood loss and complication rate. However, they may be useful in selected difficulty groups, therefore further studies addressing this issue may be beneficial.
腹腔镜肝切除术是一种可行且迅速普及但要求较高的技术，需要仔细的术前准备。由于其难度各异，已开发出多种评分系统来评估术中可能遇到的困难并合理选择病例，尤其是在学习曲线阶段。我们的目的是寻找额外的影像学参数，如肝静脉系统直径，其可能有助于评估术中可能遇到的困难并预测术后结果。
一项回顾性研究纳入了85例行腹腔镜肝切除术且术前行计算机断层扫描或磁共振成像检查的患者。根据蒙苏里互助会（IMM）评分将患者分为难度不同的3组。使用syngo.via放射学系统测量门静脉和下腔静脉的直径。进行统计分析以评估所测影像学参数与围手术期结果之间的相关性。
统计分析显示，在所有患者群体以及每个IMM组中，门静脉和脾静脉直径与围手术期结果均无相关性。肠系膜上静脉（SMV）直径与术中并发症发生率呈正相关，但仅在IMM 2组中如此。脾静脉直径<10 mm组的术中奥斯陆并发症发生率较高，而SMV直径<13 mm人群的Clavien-Dindo并发症发生率较高，但仅在IMM 2组中如此。
我们的研究表明，门静脉系统静脉和下腔静脉（IVC）直径与围手术期结果的相关性较低，似乎不是术中失血量和并发症发生率的良好预测指标。然而，它们可能在特定难度组中有用，因此针对此问题的进一步研究可能会有所帮助。
