Background: Postoperative serum ALT levels are one of the most frequently used marker to detect liver tissue damage following liver resection. The aim of this study was to evaluate if minimally invasive liver surgery (MILS) may result in less hepatic injury than open hepatectomy by assessing the differences of postoperative ALT levels. Methods: Patients who underwent MILS between 2009 and 2019 at our unit were included and compared with open liver resections. Median ALT levels was measured on postoperative day (POD) 1, 3 and 5. Postoperative peak transaminase (PPT) of ALT was determined on POD 1. The stabilized inverse probability treatment weighing (SIPTW) process was used to balance the two groups. A multivariable logistic regression analysis was used to analyze factors associated with high PPT. Results: After SIPTW, 292 MILS were compared with 159 open resections. Median ALT levels on POD 1, 3 and 5 were significantly higher in the open group than in the MILS group (301 vs. 187,p= 0.002; 180 vs. 121,p< 0.0001; 104 vs. 60,p< 0.0001; respectively). At the multivariable logistic regression analysis, MILS showed a protective effect for high PPT. Conclusions: MILS was associated with significantly lower postoperative ALT levels compared with open liver resections. MILS showed a protective effect for high PPT.
背景：术后血清丙氨酸氨基转移酶（ALT）水平是肝切除术后检测肝组织损伤最常用的指标之一。本研究旨在通过评估术后ALT水平的差异，探讨微创肝脏手术（MILS）是否比开腹肝切除术造成更轻的肝损伤。方法：纳入2009年至2019年间在我中心接受MILS的患者，并与开腹肝切除术患者进行比较。分别测量术后第1、3、5天的ALT中位水平，并确定术后第1天的ALT峰值。采用稳定逆概率处理加权（SIPTW）方法平衡两组数据，并通过多变量逻辑回归分析高ALT峰值相关因素。结果：经SIPTW处理后，292例MILS患者与159例开腹手术患者进行比较。开腹组术后第1、3、5天的ALT中位水平均显著高于MILS组（分别为301比187，p=0.002；180比121，p<0.0001；104比60，p<0.0001）。多变量逻辑回归分析显示，MILS对高ALT峰值具有保护作用。结论：与开腹肝切除术相比，MILS与显著降低的术后ALT水平相关，且对高ALT峰值具有保护作用。
肿瘤(癌症)患者之家