文章：

肝硬化患者接受微创肝切除术治疗肝细胞癌时预防术后肝衰竭：圆韧带是否应予以保留？

Prevention of Post-Hepatectomy Liver Failure in Cirrhotic Patients Undergoing Minimally Invasive Liver Surgery for HCC: Has the Round Ligament to Be Preserved?

原文发布日期：15 January 2024

DOI: 10.3390/cancers16020364

类型: Article

开放获取: 是

英文摘要：

Post-hepatectomy liver failure (PHLF) represents a major cause of morbidity and mortality after liver resection. The factors related to PHLF are represented not only by the volume and function of the future liver remnant but also by the severity of portal hypertension. The aim of this study was to assess whether the preservation of the round ligament (RL) may mitigate portal hypertension, thus decreasing the risk of PHLF and ascites in cirrhotic patients while undergoing minimally invasive liver surgery (MILS). All the cirrhotic patients who underwent MILS for HCC from 2016 to 2021 in two international tertiary referral centers were retrospectively analyzed, comparing cases with the RL preserved vs. those with the RL divided. Only patients with cirrhosis ≥ Child A6, portal hypertension, and ICG-R15 > 10% were included. Main postoperative outcomes were compared, and the risk factors for postoperative ascites (severe PHLF, grade B/C) were investigated through a logistic regression. After the application of the selection criteria, a total of 130 MILS patients were identified, with 86 patients with the RL preserved and 44 with the RL divided. The RL-preserved group showed lower incidences of severe PHLF (7.0% vs. 20.5%,p= 0.023) and ascites (5.8% vs. 18.2%,p= 0.026) in comparison with the RL-divided group. After uni/multivariate analysis, the risk factors related to postoperative ascites were RL division and platelets < 92 × 103/µL, calculated with ROC analysis. The preservation of the round ligament during MILS may mitigate portal hypertension, preventing PHLF and ascites in cirrhotic patients with borderline liver function.

摘要翻译： 

肝切除术后肝功能衰竭（PHLF）是肝脏切除术后发病和死亡的主要原因。与PHLF相关的因素不仅包括未来残余肝脏的体积和功能，还涉及门静脉高压的严重程度。本研究旨在评估在肝硬化患者接受微创肝脏手术（MILS）过程中，保留圆韧带（RL）是否能减轻门静脉高压，从而降低PHLF和腹水的风险。本研究回顾性分析了2016年至2021年间在两个国际三级转诊中心接受MILS治疗肝细胞癌（HCC）的所有肝硬化患者，比较了保留RL与离断RL的病例。仅纳入肝硬化程度≥Child A6级、存在门静脉高压且吲哚菁绿15分钟滞留率（ICG-R15）>10%的患者。比较了主要术后结局，并通过逻辑回归分析了术后腹水（严重PHLF，B/C级）的危险因素。应用筛选标准后，共纳入130例MILS患者，其中86例保留RL，44例离断RL。与RL离断组相比，RL保留组的严重PHLF（7.0% vs. 20.5%，p=0.023）和腹水（5.8% vs. 18.2%，p=0.026）发生率更低。单变量/多变量分析后，与术后腹水相关的危险因素为RL离断以及通过ROC分析计算得出的血小板计数<92×10³/µL。在MILS中保留圆韧带可能减轻门静脉高压，从而预防肝功能处于临界状态的肝硬化患者发生PHLF和腹水。

原文链接：

Prevention of Post-Hepatectomy Liver Failure in Cirrhotic Patients Undergoing Minimally Invasive Liver Surgery for HCC: Has the Round Ligament to Be Preserved?