首次开腹肝切除术后再次进行腹腔镜肝切除术

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-11-01 DOI:10.1016/j.hpb.2024.07.414

Nasser Abdul Halim , Liang Xiao , Jingwei Cai , Antonio Sa Cunha , Chady Salloum , Gabriella Pittau , Oriana Ciacio , Daniel Azoulay , Eric Vibert , Xiujun Cai , Daniel Cherqui

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引用次数: 0

摘要

复发性肝肿瘤的再次开腹肝切除术（ROH）是首选方法，尤其是在初次开腹肝切除术（OH）之后。本研究的目的是评估两家肝胆医院在初次开腹肝切除术后重复腹腔镜肝切除术（RLH）的可行性和安全性。患者来自 2012 年至 2020 年的前瞻性数据库。根据重复肝切除术的方法将患者分为两组，即ROH组和RLH组。67例患者符合标准，其中20例为RLH组，47例为ROH组。52.3%的患者诊断为肝细胞癌，7.7%为肝内胆管癌，40%为结直肠肝转移。RLH的中位手术时间和失血量（分别为199分钟和100毫升）以及总体术后并发症（20%和49%）均低于RLH（分别为199分钟和260分钟和100毫升和400毫升）。RLH有2例（10%）因粘连而转院，1例死于术后胰腺炎。RLH的中位住院时间较短（5天对9天）。RLH是一种可行、安全的技术，对于既往接受过OH手术的选定患者来说是一种值得考虑的现实选择。当粘连比预期严重时，应考虑尽早转换。

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Repeat laparoscopic liver resection after an initial open hepatectomy

Background

Repeat open hepatectomy (ROH) for recurrent liver tumors is the preferred approach especially after initial open hepatectomy (OH). The aim of this study is to assess feasibility and safety of repeat laparoscopic hepatectomy (RLH) after initial OH in 2 high volume hepato-biliary hospitals.

Methods

Patients were retrieved from prospective data bases from 2012 to 2020. The patients were divided into two groups according to the approach used for repeat hepatectomy, ROH and RLH groups.

Results

Sixty-seven patients matched the criteria, 20 in RLH and 47 in ROH. Diagnoses were hepatocellular carcinoma in 52.3%, intrahepatic cholangiocarcinoma in 7.7% and colorectal liver metastases in 40%. Median operative time and blood loss were lower in RLH (199 vs 260 min, and 100 vs 400 ml respectively), as well as overall postoperative complications (20% vs 49%). There were 2 conversions (10%) due to adhesions and one died of postoperative pancreatitis in RLH. Median hospital stay was lower in RLH (5 vs 9 days).

Conclusion

RLH is a feasible, safe technique and a realistic option to be considered in selected patients after previous OH. Early conversion should be considered when adhesions are more severe than expected.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).