Study On The Clinical Application Value Of Difficulty Scoring System In Laparoscopic Liver Resection

Objective To explore the accuracy of the four laparoscopic liver resection(LLR difficulty scores systems(DSS-B,DSS-ER,Hasegawa and Halls)in preoperative assessment of surgical difficulty and the value of predicting postoperative results,and to further analyze the risk factors of postoperative complications.Methods The retrospective cohort study was conducted.The clinical data of 168patients who underwent LLR in the First Hospital of Lanzhou University from Jun.2015 to Dec.2020 were collected.According to the preoperative clinical data,four DSSs were used to score the difficulty of each patient’s operation and divide them into differente groups.The differences of intraoperative clinical data among the scoring groups were compared to verify the accuracy of the four scores.The predictive ability of each score for short-term postoperative results was evaluated with the postoperative clinical data.The patients were divided into complication group and non complication group,and the factors with statistical difference(P<0.05)were included in the multivariate analysis to determine the independent risk factors of postoperative complications.Results A total of 168 patients were included,including 97(57.7%)males and71(42.3%)females,with an average age of 51.8±11.3 years.There were 47(28.0%)patients in the low difficulty group,66(39.3%)in the medium difficulty group,and55(32.7%)in the high difficulty group based on DSS-B score;103(61.3%),39(23.2%)and 26(15.5%)cases of low,medium and high difficulty of DSS-ER score,88(52.4%),53(31.5%)and 27(16.1%)cases of low,medium and high difficulty of Hasegawa score,and 53(31.5%),78(46.4%)and 37(22.1%)cases of low,medium and high difficulty of Halls score.Among the four difficulty scores,operative time and intraoperative blood loss increased with the increase of difficulty score,and there were statistically significant differences among all difficulty groups(P<0.05);In terms of portal occlusion rate,there were statistically significant differences in DSS-ER score and Hasegawa score among all difficulty groups(P<0.0167),DSS-B score and Halls score could not distinguish the difference between medium and high difficulty(P<0.0167);In terms of intraoperative blood transfusion rate,all the four difficulty scores could only distinguish the difference between the low and high difficulty groups(P<0.0167);In terms of conversion rate,both DSS-B score and Halls score could distinguish the difference between low and high,medium and high difficulty groups(P<0.0167),while DSS-ER score and Hasegawa score could only distinguish the difference between the low and high difficulty groups(P<0.0167).In terms of postoperative hospital stay,DSS-B score and Halls score could only distinguish the difference between low and high difficulty(P<0.05),while DSS-ER score and Hasegawa score could distinguish the difference between low and high difficulty and between low and medium difficulty(P<0.05).Only Hasegawa score could distinguish the differences among various difficulties in the incidence of postoperative complications(P<0.0167).DSS-ER score showed statistical differences among low and high difficulty groups,medium and high difficulty groups(P<0.0167).DSS-B score could only distinguish the differences between medium and high difficulty groups(P<0.0167),while Halls score could not distinguish the differences among various difficulties(P>0.05).Among the four difficulty scores,the correlation between DSS-ER score and Hasegawa score was the strongest(r=0.827,P<0.001),and Hasegawa score was the most effective in predicting postoperative complications(AUC=0.725,95%CI:0.623～0.827,P<0.001).Logistic multivariate analysis was performed on the univariate indicators that were statistically significant.The results showed that conversion to open(OR=10.086,95%CI:1.333～76.337,P=0.025),Hasegawa score>3(OR=6.921,95%CI:1.281～37.386,P=0.025),PLT<100×10~9/L(OR=6.446,95%CI:1.996～20.817,P=0.002)and intraoperative bleeding>600ml(OR=28.765,95%CI:1.338～618.49,P=0.032)were independent risk factors for complications after LLR.Conclusion DSS-B and DSS-ER can better evaluate the difficulty of LLR,and Hasegawa score has advantages in predicting the occurrence of postoperative complications.Conversion to open,Hasegawa score>3,PLT<100×10~9/L and intraoperative bleeding<600ml were independent risk factors for complications after LLR.