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Стратифициране на риска при лапароскопски чернодробни резекции: обзор на наличните скали и валидиране с българска група от пациенти

By Boris

Издание 10, Брой 2 2

Оригинал на статия / Публикувана: Ноември 2022 г.

DOI: https://www.doi.org/10.57045/jemis/1021122.pp19-28

Р. Костадинов, В. Михайлов, Цв. Тричков, С. Мърваков, В. Сираков, И. Иванов, Е. Еюпов, Н. Владов

Клиника по Чернодробно-панкреатична хирургия и трансплантология
Военномедицинска академия, София, България

Резюме

Въведение: Лапароскопската хирургия на черния дроб претърпя съществено развитие през последното десетилетие. Повишената техническа сложност предполага постъпателно увеличаване на трудността при извършване на лапароскопски чернодробни резекции, спрямо опита на хирурга. За улесняване на подбора на пациенти са създадени скали за оценка на трудността (СОТ) при лапароскопските чернодробни резекции.

Methods: We performed an analysis of a prospectively maintained database for the period January 2019 – January 2022. We identified patients, who underwent laparoscopic hepatectomy. They were staged according to the four DSS: Iwate, Institut Mutualiste Montsouris (IMM), Southampton and Hasegawa. We compared the results between the difficulty levels with the actual intraoperative parameters (Pringle-maneuver time, blood loss, hemotransfusion rate and operative time) and postoperative results. The data was evaluated using Jonckheere-Terpspa trend analysis and AUROC analysis. The correlation was assessed using Spearman’s rho.

Резултати: Идентифицирани са 60 пациенти, удовлетворяващи включващите критерии. Средната възраст на групата е 60 г., като 43% са мъже. Потвърждава се добра корелация между четирите скали и интраоперативните параметри. Нито една от СОТ не може да предвиди адекватно риска от конверсия или усложнения в следоперативния период. По отношение на риска от конверсия, най-чувствителна е IMM скалата (AUC=0,597), докато за следоперативни усложнения – скалата Hasegawa (AUC=0,612).

Заключение: Валидирани са четирите СОТ спрямо българска кохорта от пациенти. От практическа гледна точка, най-подходяща за употреба в рутинната хирургична практика е IMM скалата.

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Издание 10, Брой 2
Статия [pdf]

Ключови думи:

черен дроб, лапароскопски чернодробни резекции, скали за трудност, подбор на пациенти

Как да цитирате тази статия:

Kostadinov R, Mihailov V, Trichkov T,  Mаrvakov S, Sirakov V, Ivanov I, Eyupov E, Vladov N. Risk stratification in laparoscopic liver resections: a review of available scales and validation with a Bulgarian cohort of patients. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2022; 10(2): 19-28

Адрес за кореспонденция:

Д-р Радослав Костадинов

Военномедицинска Академия, София
Клиника по Чернодробно-панкреатична хирургия и трансплантология
Бул. “Г. Софийски” 3
София 1606, България

E-поща: radokost@gmail.com