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首页> 外文期刊>Surgical Endoscopy >A propensity-matched study of full laparoscopic versus hand-assisted minimal-invasive liver surgery
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A propensity-matched study of full laparoscopic versus hand-assisted minimal-invasive liver surgery

机译：对全腹腔镜的倾向匹配研究与手辅助最小侵袭性肝脏手术

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摘要

Background and aim The implications of multi-incision (MILS) and hand-assisted (HALS) laparoscopic techniques for minimally invasive liver surgery with regard to perioperative outcomes are not well defined. The purpose of this study was to compare MILS and HALS using propensity score matching. Methods 309 patients underwent laparoscopic liver resections (LLR) between January 2013 and June 2018. Perioperative outcomes were analyzed after a 1:1 propensity score match. Subgroup analyses of matched groups, i.e., radical lymphadenectomy (LAD) as well as resections of posterosuperior segments (VII and/or VIII), were performed. Results MILS was used in 187 (65.2%) and HALS in 100 (34.8%) cases, with a significant decrease of HALS resections over time (p = 0.001). There were no significant differences with regard to age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) Score, previous abdominal surgery and cirrhosis between both groups. Patients scheduled for HALS were characterized by a significantly higher rate of malignant tumors (p < 0.001) and major resections (p < 0.001). After propensity score matching (PMS), 70 cases remained in each group and all preoperative variables as well as resection extend were well balanced. A significantly higher rate of radical LAD (p = 0.039) and posterosuperior resections was found in the HALS group (p = 0.021). No significant differences between the matched groups were observed regarding operation time, conversion rate, frequency of major complications, length of intensive care unit (ICU) stay, overall hospital stay and R1 rate. Conclusion Our analysis suggests MILS and HALS to be equivalent regarding postoperative outcomes. HALS might be particularly helpful to accomplish complex surgical procedures during earlier stages of the learning curve.
机译：背景与目的多切口（MILS）和手助（HALS）腹腔镜技术在微创肝脏手术中对围手术期结局的影响尚不明确。本研究的目的是使用倾向评分匹配来比较MIL和HAL。方法2013年1月至2018年6月，309例患者接受了腹腔镜肝切除术（LLR）。在1:1倾向评分匹配后分析围手术期结果。对匹配组进行亚组分析，即根治性淋巴结切除术（LAD）和后上节段切除术（VII和/或VIII）。结果187例（65.2%）使用MILS，100例（34.8%）使用HALS，随着时间的推移，HALS切除率显著降低（p=0.001）。两组在年龄、性别、体重指数（BMI）、美国麻醉师协会（ASA）评分、既往腹部手术和肝硬化方面均无显著差异。接受HALS治疗的患者恶性肿瘤发生率（p<0.001）和大手术切除率（p<0.001）显著较高。在倾向评分匹配（PMS）后，每组仍有70例患者，所有术前变量以及切除范围都很平衡。HALS组根治性LAD（p=0.039）和后上叶切除率显著高于HALS组（p=0.021）。在手术时间、转化率、主要并发症发生率、重症监护病房（ICU）住院时间、总住院时间和R1发生率方面，两组间无显著差异。结论我们的分析表明，在术后结果方面，MILS和HALS是等效的。在学习曲线的早期阶段，HALS可能对完成复杂的外科手术特别有帮助。

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  • 来源
    《Surgical Endoscopy》 |2021年第5期|共8页
  • 作者

    Wabitsch S.; Schoening W.; Kaestner A.; Haber P. K.; Benzing C.; Krenzien F.; Lenz K.; Schmelzle M.; Pratschke J.;

  • 作者单位

    Charite Univ Med Berlin Campus Charite Mitte Dept Surg Augustenburger Pl 1 Berlin 13353 Germany;

    Charite Univ Med Berlin Campus Charite Mitte Dept Surg Augustenburger Pl 1 Berlin 13353 Germany;

    Charite Univ Med Berlin Campus Charite Mitte Dept Surg Augustenburger Pl 1 Berlin 13353 Germany;

    Charite Univ Med Berlin Campus Charite Mitte Dept Surg Augustenburger Pl 1 Berlin 13353 Germany;

    Charite Univ Med Berlin Campus Charite Mitte Dept Surg Augustenburger Pl 1 Berlin 13353 Germany;

    Charite Univ Med Berlin Campus Charite Mitte Dept Surg Augustenburger Pl 1 Berlin 13353 Germany;

    Charite Univ Med Berlin Campus Charite Mitte Dept Biometry &

    Clin Epidemiol Berlin Germany;

    Charite Univ Med Berlin Campus Charite Mitte Dept Surg Augustenburger Pl 1 Berlin 13353 Germany;

    Charite Univ Med Berlin Campus Charite Mitte Dept Surg Augustenburger Pl 1 Berlin 13353 Germany;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 诊断学;
  • 关键词

    Laparoscopic liver surgery; Hepatobiliary surgery; Operation method; Operation technique;

    机译：腹腔镜肝脏手术;肝胆外科;操作方法;操作技术;

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