全腹腔镜供肝获取儿童亲属活体肝移植的临床疗效分析

Clinical efficacy of laparoscopic and open left lateral lobehepatectomy for living donor pediatric liver transplantation

目的比较腹腔镜与开腹儿童亲属活体肝移植左外叶供肝切取手术的临床疗效。方法采用回顾性队列研究方法收集2016年10月至2018年10月实施的65例腹腔镜亲属活体供肝切取手术供者的临床资料,其中男性供者14例,女性供者51例。同时在该时期内由同一手术组完成的开腹左外叶供肝切取手术男女性供者中分别按照区组随机化方法选取相同例数作为开腹对照组。对照研究两组供者手术及术后并发症发生情况以及供者远期随访身心健康状况。采用门诊和电话方式进行随访,了解供者术后恢复及术后并发症情况。随访时间截至2018年11月。结果腹腔镜手术组中,1例供者由于术中肝静脉属支汇合部破裂出血中转为开腹手术,其余供者均顺利完成腹腔镜左外叶供肝切取手术。腹腔镜组供者手术时间为(216.0±36.5)min,术中出血量为(56.0±44.3)ml,供肝热缺血时间(6.4±3.8)min。开腹手术组全部65例供者均顺利完成手术。开腹手术组手术时间为(167.0±19.7)min,术中出血量为(138.0±59.4)ml,供肝热缺血时间(1.4±0.5)min。两组供者上述指标比较,差异均有统计学意义(P<0.05)。腹腔镜组与开腹手术组供者术后切口并发症发生率分别为3.54%和2.51%;腹腔镜手术组术后首次通气时间为(52.3±4.9)h,术后住院时间为(4.2±0.4)d;开腹组术后首次通气时间为(62.6±4.1)h ,术后住院时间为(5.0±0.6)d,两组供者之间比较,首次通气时间差异具有统计学意义(P<0.05),平均住院日差别无统计学意义。130例供者均未输血,术后均顺利出院。结论腹腔镜下亲属活体左外叶供肝切取术可获得与传统开腹手术同等的安全性,并且可以降低手术对供者带来的身心损伤,是亲属活体肝移植供肝切取手术方式的一种合理选择。

Objective To compare the clinical efficacy of laparoscopiceft and open left lateral lobe hepatectomy for living donor liver transplantation in children. Methods The retrospective cohort study was conducted. The clinical data of 65 cases (14 males and 51 females) receiving laparoscopic living donor liver resection from October 2016 to October 2018 were analyzed. At the same time, the same number of male and female donors who underwent open left lateral lobe hepatectomy performed by the same group during the same period were randomly selected as the control group. The occurrence of complications and long-term follow-up of physical and mental health were compared between the two groups. Follow-up using outpatient examination and telephone interview was performed to detect postoperative recovery and complications up to November 2018. Results Intraoperative conditions: In the laparoscopic operation group, one donor was converted to open operation due to the confluence of the middle hepatic vein branches bleeding during the operation, and the rest donors successfully completed the laparoscopic left lateral lobe hepatectomy. The operation time of laparoscopic group was (216.0±36.5) min, the amount of bleeding during operation was (56.0±44.3) mL, and the warm ischemia time of donor liver was (6.4±3.8) min. All 65 donors in open operation group successfully completed the operation. The operation time was (167.0±19.7) min, the amount of bleeding was (138.0±59.4) mL, and the time of warm ischemia of donor liver was (1.4±0.5) min. There were significant differences in the above indexes between the two groups (P<0.05). Postoperative complications: The incidence of incision fat liquefaction was 3.54% and 2.51% respectively in laparoscopic group and open group. The time to first anal exhaust after operation of laparoscopic and open groups was (52.3±4.9) h vs.(62.6±4.1) h, P < 0.05. The average length of hospitalization in laparoscopic and open groups was (4.2±0.4) days vs.(5.0±0.6) days, P > 0.05. Conclusions Laparoscopic left lateral lobe living donor liver resection can achieve the same safety as traditional open surgery, and can reduce the physical and mental injury of donors. It is a reasonable choice for living donor liver transplantation.