Two hundred and forty-one consecutive liver resections: an experience from India.
Two hundred and forty-one consecutive liver resections: an experience from India.
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DOI：
10.1080/13651820600985259
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发表时间：
2007-01-01
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影响因子：
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通讯作者：
Nundy, Samiran
中科院分区：
文献类型：
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作者：
Marwah, Sanjay;Khan, Mohammed Mustafizur Rahman;Nundy, Samiran
背景：虽然肝切除在西方国家和东南亚已经成为一种成熟的手术，但在印度的大多数中心仍然不经常进行。在过去的10年里，新成立的专业单位进行了更多的肝脏切除术，但没有重大的系列报道。患者和方法：我们分析了Gyan Burman肝脏科，Sir Ganga Ram医院的241例肝脏切除术的结果，将我们的结果与已建立的中心发表的结果进行比较，并确定与发病率和死亡率相关的因素。为了检验更多经验对手术的影响，我们比较了1996-2000年（第一期）和2001-2005年（第二期）的手术结果。结果：总病死率和总发病率分别为6.6%和44.8%，与最近发表的西方系列相当。12.4%的患者出现危及生命的并发症。多因素分析显示，合并症、术中输血量为bbb30单位、肝细胞癌合并肝硬化、胆囊癌合并黄疸是发病的独立危险因素，合并症和肝硬化是死亡的危险因素。在第二阶段，手术数量有所增加（66例对175例；第一阶段对第二阶段），但死亡率基本保持不变（6.1%对6.8%）。讨论：在印度可以安全地进行肝切除术，其结果与西方相当。经验的增加并没有降低总体死亡率。也许更仔细的患者选择和更好的合并症围手术期管理可以进一步降低发病率和死亡率。
BACKGROUND: Although liver resection has become an established procedure in western countries and South-east Asia it is still not performed frequently in most centres in India. In the last 10 years newly created specialized units have been performing more liver resections but no major series have been reported.PATIENTS AND METHODS: We analysed the results of 241 hepatic resections in the Gyan Burman Liver Unit, Sir Ganga Ram Hospital to compare our results with those published from established centres and to identify the factors relating to morbidity and mortality. To examine the effect of a greater experience with the procedure we compared the outcome of our operations from 1996-2000 (first period) and those from 2001-2005 (second period).RESULTS: The overall mortality and morbidity rates were 6.6% and 44.8%, respectively, which are comparable with those of most recently published Western series. Life-threatening complications occurred in 12.4% patients. Multivariate analysis showed that the presence of comorbid conditions, intraoperative blood transfusions of >3 units, hepatocellular carcinoma with underlying cirrhosis and gall bladder carcinoma with jaundice were the independent risk factors for morbidity, whereas the presence of comorbid illness and underlying liver cirrhosis were the risk factors for mortality. During the second period there was an increase in the number of operations performed (66 vs 175; first vs second period), but the mortality rates remained essentially unchanged (6.1% vs 6.8%).DISCUSSION: Hepatic resections can be performed safely in India with results comparable to those achieved in the West. Increasing experience did not reduce overall mortality. Perhaps more careful patient selection and better perioperative management of comorbid illnesses may reduce the morbidity and mortality further.