PDF(Pubmed)
Abstract：
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：
肝切除术后肝功能衰竭（PHLF）是肝切除术后发病率和死亡率的主要原因。与PHLF相关的因素不仅表现为未来肝脏残存的体积和功能，还表现为门静脉高压的严重程度。这项研究的目的是评估保留圆形韧带（RL）是否可以减轻门静脉高压症，从而降低肝硬化患者在接受微创肝脏手术（MILS）时发生PHLF和腹水的风险。回顾性分析2016年至2021年在两个国际三级转诊中心接受肝癌MILS的所有肝硬化患者，将案例与保留的RL进行比较那些与RL分开的。只有肝硬化患者≥ChildA6，门静脉高压，包括ICG-R15>10%。术后主要结局比较,以及术后腹水的危险因素(严重的PHLF，B/C级)通过逻辑回归进行调查。应用选择标准后，总共确定了130名MILS患者，86例RL保留，44例RL分开。保留RL组的严重PHLF发生率较低（7.0%vs.20.5%,p=0.023）和腹水（5.8%vs.18.2%,与RL划分组相比，p=0.026）。在单/多变量分析之后，与术后腹水相关的危险因素是RL分裂和血小板<92×103/µL，用ROC分析计算。在MILS期间保留圆形韧带可能会减轻门静脉高压症，在肝功能临界的肝硬化患者中预防PHLF和腹水。
