Risk of nonshunt abdominal operation in the patient with cirrhosis.
Risk of nonshunt abdominal operation in the patient with cirrhosis.
复制标题
肝硬化患者进行非分流腹部手术的风险。
DOI：
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发表时间：
1994
影响因子：
5.2
通讯作者：
D. Witzke
中科院分区：
文献类型：
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作者：
R. Wong;W. Rappaport;C. Witte;G. Hunter;P. Jaffe;K. Hall;D. Witzke
背景
手术治疗肝硬化患者静脉曲张出血和顽固性腹水的危险性是众所周知的。关于这些患者腹部手术后的发病率和死亡率的信息少得多，与门静脉高压症的后遗症没有直接关系。
研究设计
我们回顾了10年期间85例普通外科腹部手术患者中77例经组织学证实的肝硬化病例的记录。对32个术前和术中变量进行Logistic回归分析。
结果
男47例，女30例，平均年龄61岁（范围28 - 86岁）。30天死亡率为18%（77名患者中有15名）。急诊手术的死亡率为32%（35例患者中有11例），而择期手术的死亡率为8%（50例患者中有4例）（p < 0.05）。28%的患者发生了广泛的并发症（24例患者; 14%在择期手术治疗后，49%在紧急手术后）。胃手术后死亡率最高（38%）。与术后不良结局相关的其他具有统计学意义（p < 0.05）的因素包括恶病质、术前输注新鲜冷冻血浆和术中输注血小板。令人惊讶的是，手术失血量、腹水的存在和手术时间与并发症或死亡的增加无关。
结论
我们的结论是，选择性，非分流腹部手术可以进行可接受的发病率和死亡率在选定的肝硬化患者。
BACKGROUND
The hazards of operative treatment for variceal hemorrhage and intractable ascites in patients with cirrhosis are well known. Much less information is available on the morbidity and mortality in these patients after abdominal operations not directly related to the sequelae of portal hypertension.
STUDY DESIGN
We reviewed the records of 77 consecutive histologically proved cases of cirrhosis in patients undergoing 85 general surgical, abdominal procedures during a ten year period. Logistic regression analysis was done on 32 preoperative and intraoperative variables with relation to postoperative outcome.
RESULTS
There were 47 men and 30 women, with a mean age of 61 years (range of 28 to 86 years). The 30-day mortality rate was 18 percent (15 of 77 patients). Emergent operation was associated with a mortality rate of 32 percent (11 of 35 patients) compared with 8 percent (four of 50 patients) after elective procedures (p < 0.05). Extensive complications occurred in 28 percent of patients (24 patients; 14 percent after elective operative treatment and 49 percent after emergent procedures). The mortality rate was greatest after gastric procedures (38 percent). Other factors of statistical significance (p < 0.05) associated with poor postoperative outcome included cachexia, preoperative transfusion of fresh frozen plasma, and intraoperative platelet transfusion. Surprisingly, operative blood loss, presence of ascites, and operative time were not associated with increased complications or death.
CONCLUSIONS
We conclude that elective, nonshunt abdominal operations can be performed with acceptable morbidity and mortality rates in selected patients with cirrhosis.