Practicability of surgical difficulty scoring model for laparoscopic liver resection

doi:10.3877/cma.j.issn.1674-6899.2020.03.009

Abstract

Abstract:

Objective

To use the surgical difficulty scoring model for laparoscopic liver resection to evaluate the difficulty of surgery, and to analyze the practicability of scoring model by comparing the differences between each difficulty groups.

Methods

The clinical data of 68 patients were reviewed in this study, who underwent a pure laparoscopic liver resection in the department of (minimally invasive) Hepatobiliary of General Surgery, Jinzhou Medical University Affiliated First Hospital, from Oct. 2016 to Oct.2019. First, the characteristics and surgical outcomes during perioperative period were collected. Next, these cases were scored by using the scoring models, respectively presented by Hasegawa (scoring model of Hasegawa, SM-H) and Ban (scoring system of Ban, SS-B), then divided into groups of different difficulty. Finally, the practicability of the scoring model in practical application was evaluated by comparing differences among each groups on the factors of the blood loss in surgery, the length of surgical time and the length of hospital stay.

Results

There were significant differences(P<0.05) in the blood loss, length of surgical time and length of hospital stay between the low difficulty group and medium difficulty group by adopting SM-H. And by applied the SM-B, there were no significant differences(P>0.05) could be found between the low difficulty group and medium difficulty group, in the factors of blood loss, surgical time or length of hospital stay.

Conclusions

SM-H, this laparoscopic liver resection surgical difficulty scoring model could provide a very intuitive quantitative way for hepatobiliary surgeons to evaluate the difficulty of surgery before performing laparoscopic liver resection in low or medium difficulty cases. SM-B has some reference significance in estimating blood loss, surgical time or length of hospital stay in the case of low and mid-difficult laparoscopic liver removal.

Key words: Laparoscopic, Liver resection, Scoring model, Practicability

Adong Xia, Wei Wang, Guang Bai, Yifan Zhang, Tao Yang, Yinpeng Huang. Practicability of surgical difficulty scoring model for laparoscopic liver resection[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2020, 13(03): 166-172.

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Figures/Tables 13

References 34

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参考文献	时间	手术难度衡量指标	提出模型
Ban等^{[ 6 ]}	2014年	基于专家主观判断	10级难度评分系统
Hasegawa等^{[ 7 ]}	2017年	手术时间	难度评分模型
Kawaguchi等^{[ 8 ]}	2018年	手术时间、出血量及转换^A	基于切除范围的难度分级模型
Tong等^{[ 9 ]}	2018年	转换及术后并发症^A	转换及术后并发症风险预估模型^A
Halls等^{[ 10 ]}	2018年	术中并发症	术中并发症风险等级模型

参考文献	时间	手术难度衡量指标	提出模型
Ban等^{[ 6 ]}	2014年	基于专家主观判断	10级难度评分系统
Hasegawa等^{[ 7 ]}	2017年	手术时间	难度评分模型
Kawaguchi等^{[ 8 ]}	2018年	手术时间、出血量及转换^A	基于切除范围的难度分级模型
Tong等^{[ 9 ]}	2018年	转换及术后并发症^A	转换及术后并发症风险预估模型^A
Halls等^{[ 10 ]}	2018年	术中并发症	术中并发症风险等级模型

纳入患者	56例
年龄(岁)	55(41～66)
性别(男/女)[例(%)]	30(53.6%)/26(46.4%)
切除方式^A[例(%)]	34(60.7%)/19(5.4%)/0(0.0%)/3(33.9%)
肿瘤的定位(S2～8)[例(%)]	18(32.1%)/10(17.9%)/8(14.3%)/5(8.9%)/0(0.0%)/6(10.7%)/9(16.1%)
BMI(kg/m²)	22.9(20.9～23.4)
PLT≤100×10⁹/L[例(%)]	12(21.4%)
SM-H得分(0/1/2/3/4/5分)[例(%)]	30(53.6%)/8(14.3%)/6(10.7%)/12(21.4%)/0(0.0%)/0(0.0%)
SM-H难度分级^B[例(%)]	38(67.9%)/18(32.1%)/0(0.0%)
肿瘤大小(cm)	4.0(2.6～5.5)
邻近或侵犯大血管[例(%)]	0(0.0%)
恶性肿瘤[例(%)]	10(17.2%)
Child-Pugh A[例(%)]	53(94.6%)
SM-B得分(1/2/3/4/5/6/7/8/9/10分)[例(%)]	2(3.6%)/7(12.5%)/2(3.6%)/8(14.3%)/25(44.6%)/6(10.7%)/0(0.0%)/3(5.4%)/1(1.8%)/2(3.5%)
SM-B难度分级^C[例(%)]	11(19.6%)/39(69.6%)/6(10.7%)
手术时间(min)	145(96～165)
术中出血量(ml)	100(50～100)
术后并发症[例(%)]	6(10.7%)
并发症≥3级[例(%)]	0(0.0%)
住院时间(d)	10(8～12)

纳入患者	56例
年龄(岁)	55(41～66)
性别(男/女)[例(%)]	30(53.6%)/26(46.4%)
切除方式^A[例(%)]	34(60.7%)/19(5.4%)/0(0.0%)/3(33.9%)
肿瘤的定位(S2～8)[例(%)]	18(32.1%)/10(17.9%)/8(14.3%)/5(8.9%)/0(0.0%)/6(10.7%)/9(16.1%)
BMI(kg/m²)	22.9(20.9～23.4)
PLT≤100×10⁹/L[例(%)]	12(21.4%)
SM-H得分(0/1/2/3/4/5分)[例(%)]	30(53.6%)/8(14.3%)/6(10.7%)/12(21.4%)/0(0.0%)/0(0.0%)
SM-H难度分级^B[例(%)]	38(67.9%)/18(32.1%)/0(0.0%)
肿瘤大小(cm)	4.0(2.6～5.5)
邻近或侵犯大血管[例(%)]	0(0.0%)
恶性肿瘤[例(%)]	10(17.2%)
Child-Pugh A[例(%)]	53(94.6%)
SM-B得分(1/2/3/4/5/6/7/8/9/10分)[例(%)]	2(3.6%)/7(12.5%)/2(3.6%)/8(14.3%)/25(44.6%)/6(10.7%)/0(0.0%)/3(5.4%)/1(1.8%)/2(3.5%)
SM-B难度分级^C[例(%)]	11(19.6%)/39(69.6%)/6(10.7%)
手术时间(min)	145(96～165)
术中出血量(ml)	100(50～100)
术后并发症[例(%)]	6(10.7%)
并发症≥3级[例(%)]	0(0.0%)
住院时间(d)	10(8～12)

组别	例数	年龄(岁)	BMI(kg/m²)	PLT<100×10⁹/L[例(%)]
低度困难	38	55(42～63)	23.1(20.2～23.9)	3(7.9%)
中度困难	18	57(51～66)	22.48(21.1～23.0)	9(50.0%)
统计值	?	t＝252	t＝270	χ²＝10.48
P值	?	0.113	0.206	0.001

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