腹腔镜肝切除术中症状性静脉气体栓塞的发生率及危险因素。

IF 2.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences Pub Date : 2025-10-09 DOI:10.1002/jhbp.70013

Walid Hadji, Nassiba Beghdadi, Chady Salloum, Claire Goumard, Safi Dokmak, Chetana Lim, Stéphanie Roullet, Rania Bounab, Djillali Annane, Mickaël Lesurtel, Olivier Scatton, Daniel Cherqui, Marc Antoine Allard

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引用次数: 0

摘要

背景：腹腔镜肝切除术（LLR）中症状性静脉气体栓塞（GE）的危险因素尚不清楚。本研究的目的是报告LLR期间症状性GE的发生率、危险因素和发病率。方法：回顾性研究所有在法国3个中心连续3年接受LLR的患者。收集并回顾所有术中事件，重点是症状性静脉GE。结果：在518例LLR（507例）患者中，26例（5%）出现了症状性GE。GE后无GE相关死亡或神经系统后遗症。GE组和非GE组在基线特征、切除类型、气腹压力（93%的LLR≤12 mmHg）或术中出血方面相似。GE后的总体发病率和住院时间更长。在12 mmHg的Airseal充气系统下，GE的概率更高（Airseal为7.1%，常规系统为0.59%，优势比为12.73,95%可信区间[2.66-228.4],p = 0.013）。结论：我们的研究结果表明，12mmhg或更高的AirSeal是症状性静脉GE的危险因素。在LLR期间，应评估低压充气或替代充气系统。

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Incidence and Risk Factors of Symptomatic Venous Gas Embolism During Laparoscopic Liver Resection.

Background: Risk factors of symptomatic venous gas embolism (GE) during laparoscopic liver resection (LLR) are poorly known. The objective of this study was to report the incidence, risk factors, and morbidity of symptomatic GE during LLR.

Methods: All consecutive patients who underwent LLR in 3 French centers over 3 years were retrospectively studied. All intraoperative events, with a focus on symptomatic venous GE, were collected and reviewed.

Results: Among the 518 LLR (507 patients) studied, 26 (5%) cases of symptomatic GE occurred. There was no GE-related death nor neurological sequelae after GE. The group of patients with GE and without GE was similar in terms of baseline characteristics, type of resection, and pneumoperitoneum pressure (≤ 12 mmHg in 93% of LLR) or intraoperative bleeding. Overall morbidity and length of stay were longer after GE. The probability of GE was higher under the Airseal insufflation system at 12 mmHg (7.1% with Airseal versus 0.59% with conventional systems, odds ratio 12.73, 95% confidence interval [2.66-228.4], p = 0.013).

Conclusion: Our results suggest that AirSeal at 12 mmHg or more is a risk factor for symptomatic venous GE. Insufflation with lower pressure or alternative insufflation systems should be evaluated during LLR.

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来源期刊

Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY

自引率

10.00%

发文量

178

审稿时长

6-12 weeks

期刊介绍： The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.