Risk factors for major morbidity after hepatectomy for hepatocellular carcinoma in 293 recent cases
Risk factors for major morbidity after hepatectomy for hepatocellular carcinoma in 293 recent cases
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DOI：
10.1007/s00534-010-0275-3
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发表时间：
2010-09-01
影响因子：
3
通讯作者：
Ohnishi, Teppei
中科院分区：
文献类型：
--
作者：
Sadamori, Hiroshi;Yagi, Takahito;Ohnishi, Teppei
背景/目的本研究的目的是确定肝细胞癌（HCC）切除术后主要并发症的危险因素。方法对2001年至2008年期间293例HCC切除术后主要并发症的危险因素进行单因素和多因素分析。结果243例HCC切除术后主要并发症的危险因素为：82.9%的患者接受了解剖性肝切除术，50例患者（17.1%）接受了再次肝切除术。胆漏和腹腔脓肿的发生率分别为12.9%和9.2%。胆漏的危险因素是手术时间>= 300 min，腹腔脓肿的危险因素是再次肝切除术（比值比分别为4.9和5.3）。需要内镜治疗或经皮经鞘胆管引流的胆漏的主要原因是术前存在的胆管解剖结构的潜在狭窄，由既往HCC治疗引起。耐甲氧西林金黄色葡萄球菌是腹腔内脓肿的主要致病菌后，重复hepatectomy.Conclusions我们最近的系列研究表明，手术时间延长和重复肝切除术的独立危险因素胆漏和腹腔内脓肿，分别为肝癌切除术后。对于既往接受过多种HCC治疗（包括肝切除术）的患者，应考虑术前评估胆道解剖结构，以减少需要进行侵入性治疗的胆漏。
Background/Purpose The purpose of this study was to identify risk factors for major morbidity after hepatectomies for hepatocellular carcinoma (HCC).Methods Univariate and multivariate analyses of risk factors for major morbidity were performed in 293 patients who underwent hepatectomy for HCC between 2001 and 2008.Results Two hundred and forty-three patients (82.9%) underwent an anatomic hepatectomy, and a repeat hepatectomy was performed in 50 patients (17.1%). The prevalences of bile leakage and intraabdominal abscess were 12.9% and 9.2%, respectively. The risk factor for bile leakage was an operative time >= 300 min and the risk factor for intraabdominal abscess was a repeat hepatectomy (odds ratios = 4.9 and 5.3, respectively). The main cause of bile leakage that made endoscopic therapy or percutaneous transhepatic biliary drainage necessary was a latent stricture of the biliary anatomy that had existed preoperatively, caused by previous treatments for HCC. Methicillin-resistant Staphylococcus aureus was the main causative bacteria of intraabdominal abscess after repeat hepatectomies.Conclusions Our recent series revealed that prolonged operative time and repeat hepatectomy were independent risk factors for bile leakage and intraabdominal abscess, respectively, after hepatectomies for HCC. Preoperative assessment of the biliary anatomy should be considered for patients who have had previous multiple treatments for HCC, including hepatectomy, to reduce bile leakage that makes invasive treatment necessary.