荧光腹腔镜在儿童活体肝移植左外叶供肝切取术中的应用

Clinical application of fluorescence laparoscopy in living donor left lateral sectionectomy for pediatric liver transplantation

目的比较荧光腹腔镜与普通腹腔镜供肝切取手术的临床疗效,探讨荧光胆管显影技术在儿童活体肝移植左外侧叶供肝切取手术中的应用价值。方法回顾性研究2016年10月至2023年8月上海交通大学医学院附属仁济医院肝脏外科实施的302例腹腔镜下左外叶供肝切取手术的供受者临床资料,根据是否使用荧光腹腔镜设备手术将供者分为普通腹腔镜组(90例)和荧光腹腔镜组(212例)。经倾向性评分匹配处理后两组各入组88对活体肝移植供受者。对照分析两组供者的手术时间、供肝热缺血时间、移植物胆管开口数,术后第1、3天肝功能指标和并发症发生率;对照分析2组受者的术后第1、3天肝功能指标和并发症发生率等围手术期资料。采用SPSS 27.0统计软件进行分析。采用独立样本t检验、Mann-Whitney U检验和卡方检验来分析两组之间的差异。结果荧光腹腔镜组和普通腹腔镜组移植物左肝管单支开口占比分别为84.1%(74/88)和70.5%(62/88),组间比较,差异有统计学意义(P=0.031);两组供者的术后肝功能恢复和术后短期并发症比较,组间差异无统计学意义(P>0.05);两组受者的术后短期肝功能恢复和术后住院天数方面比较,组间差异无统计学意义(P>0.05);荧光腹腔镜组受者未出现胆道并发症,普通腹腔镜组受者胆道并发症发生率为3.4%(3/88),但组间差异无统计学意义(P>0.05)。结论荧光腹腔镜下活体肝移植左外叶供肝切取手术能够提高供受者手术安全性。

Objective To compare the clinical efficacy of fluorescent laparoscopy versus conventional laparoscopy for living-donor hepatectomy and explore the application value of fluorescent cholangiography in pediatric living donor liver transplantation(LT)using left lateral lobe.Methods From October 2016 to August 2023,retrospective analysis was conducted for the relevant clinical data from 302 recipients of laparoscopic left lateral lobe donor hepatectomy.There were 90 cases in conventional laparoscopy group and 212 cases in fluorescent laparoscopy group.After propensity score matching(PSM),88 patients were enrolled into each group.The perioperative data such as operative duration,donor liver thermal ischemic time,number of graft bile duct openings,liver function parameters and complication rates at Day 1/3 postoperation of donors and recipients were compared between two groups.SPSS 27.0 statistical software was utilized for analysis.Independent sample t,Mann-Whitney U and chisquare tests were utilized for examining the inter-group differences.Results In fluorescent laparoscopy group,the proportion of grafts with a single open left hepatic duct was 84.1%(74/88)versus 70.5%(62/88)in conventional laparoscopy group with statistically significant difference(P=0.031).No statistically significant inter-group differences existed in postoperative liver function recovery or short-term postoperative complications(P>0.05).No statistically significant inter-group differences existed in short-term postoperative liver function recovery or hospitalization length(P>0.05).In terms of biliary complications,fluorescent laparoscopy group had no biliary complications while the incidence of biliary complications was 3.4%(3/88)in conventional laparoscopy group.However,inter-group difference was statistically insignificant(P>0.05).Conclusions Living-donor LT using left lateral lobe under fluorescent laparoscopy may enhance the surgical safety for both donors and recipients.