手助腹腔镜肝切除术与开放性肝切除术的手术结果:一项回顾性倾向评分匹配队列研究

IF 7 2区 医学 Q1 ONCOLOGY Chinese Journal of Cancer Research Pub Date : 2019-10-01 DOI:10.21147/j.issn.1000-9604.2019.05.11
Shengtao Lin, Fan Wu, Liming Wang, Yunhe Liu, Yiling Zheng, Tana Siqin, W. Rong, Jianxiong Wu
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Results During this period, 232 patients with a median age of 55.1 years old received OLR, while 49 patients with a median age of 54.7 years old received HALLR. Compared with HALLR group, OLR group has a higher proportion in male patients (190/232, 81.9% vs. 34/49, 69.4%, P=0.048) and lower albumin (43.2±4.5 vs. 44.8±3.7, P=0.020). After PSM, 49 patients from each group were included in the following analysis. Two groups were well balanced in their baseline characteristics, liver functions, preoperative treatments, abdominal surgery history, and surgical difficulty. None perioperative mortality was observed in both groups. Operation time and postoperative complications were similar in two groups (P=0.935, P=0.056). The HALLR group showed less bleeding amount (177.8±217.1 mL vs. 283.1±225.0 mL, P=0.003) and shorter postoperative stay period (6.9±2.2 d vs. 9.0±3.5 d, P=0.001). 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引用次数: 4

摘要

目的手辅助腹腔镜肝切除术具有开放手术和腹腔镜手术的优点。手辅助腹腔镜肝切除术(HALLR)与开放肝切除术(OLR)的手术效果比较尚缺乏。本研究比较了两种方法在匹配良好的患者队列中的手术结果。方法回顾性研究2014年1月至2017年10月在中国医学科学院肿瘤医院和北京协和医学院行肝切除术的患者。采用倾向评分匹配(PSM)来减少两组间的选择偏倚。比较两组手术及短期手术效果。结果232例患者接受OLR治疗,中位年龄55.1岁,49例患者接受HALLR治疗,中位年龄54.7岁。与HALLR组相比,OLR组男性患者比例较高(190/232,81.9%比34/49,69.4%,P=0.048),白蛋白较低(43.2±4.5比44.8±3.7,P=0.020)。经PSM后,每组49例患者纳入以下分析。两组患者的基线特征、肝功能、术前治疗、腹部手术史和手术难度均平衡良好。两组患者围手术期均无死亡。两组手术时间及术后并发症相似(P=0.935, P=0.056)。HALLR组出血量少(177.8±217.1 mL比283.1±225.0 mL, P=0.003),术后住院时间短(6.9±2.2 d比9.0±3.5 d, P=0.001)。结论手辅助腹腔镜手术在肝切除术中是可行和安全的,包括一些困难的病例。HALLR可以更好地控制出血,术后恢复更快。
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Surgical outcomes of hand-assisted laparoscopic liver resection vs. open liver resection: A retrospective propensity score-matched cohort study
Objective Hand-assisted laparoscopic liver resection has the advantages of open and laparoscopic surgeries. There is still lack of comparison of surgical outcomes between hand-assistied laparoscopic liver resection (HALLR) and open liver resection (OLR). This study compared the surgical outcomes of the two approaches between well-matched patient cohorts. Methods Patients who received liver resection during January 2014 and October 2017 in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were included in this retrospective study. Propensity score matching (PSM) was performed to reduce selection bias between the two groups. Operation and short-term surgical outcomes were compared between the well matched groups. Results During this period, 232 patients with a median age of 55.1 years old received OLR, while 49 patients with a median age of 54.7 years old received HALLR. Compared with HALLR group, OLR group has a higher proportion in male patients (190/232, 81.9% vs. 34/49, 69.4%, P=0.048) and lower albumin (43.2±4.5 vs. 44.8±3.7, P=0.020). After PSM, 49 patients from each group were included in the following analysis. Two groups were well balanced in their baseline characteristics, liver functions, preoperative treatments, abdominal surgery history, and surgical difficulty. None perioperative mortality was observed in both groups. Operation time and postoperative complications were similar in two groups (P=0.935, P=0.056). The HALLR group showed less bleeding amount (177.8±217.1 mL vs. 283.1±225.0 mL, P=0.003) and shorter postoperative stay period (6.9±2.2 d vs. 9.0±3.5 d, P=0.001). Conclusions We demonstrated that hand-assisted laparoscopic surgery is feasible and safe for liver resection, including some difficult cases. HALLR can provide better bleeding control and faster recovery after surgery.
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来源期刊
自引率
9.80%
发文量
1726
审稿时长
4.5 months
期刊介绍: Chinese Journal of Cancer Research (CJCR; Print ISSN: 1000-9604; Online ISSN:1993-0631) is published by AME Publishing Company in association with Chinese Anti-Cancer Association.It was launched in March 1995 as a quarterly publication and is now published bi-monthly since February 2013. CJCR is published bi-monthly in English, and is an international journal devoted to the life sciences and medical sciences. It publishes peer-reviewed original articles of basic investigations and clinical observations, reviews and brief communications providing a forum for the recent experimental and clinical advances in cancer research. This journal is indexed in Science Citation Index Expanded (SCIE), PubMed/PubMed Central (PMC), Scopus, SciSearch, Chemistry Abstracts (CA), the Excerpta Medica/EMBASE, Chinainfo, CNKI, CSCI, etc.
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