Risk Factors of Hospital Mortality after Re-laparotomy for Post-hepatectomy Hemorrhage
Risk Factors of Hospital Mortality after Re-laparotomy for Post-hepatectomy Hemorrhage
复制标题
肝切除术后出血再次开腹手术医院死亡的危险因素
DOI：
10.1007/s00268-013-2147-x
复制
发表时间：
2013-06
影响因子：
2.6
通讯作者：
杨田
中科院分区：
文献类型：
--
作者：
杨田
肝切除术后出血（PHH）需要再次剖腹手术是一种危及生命的情况，并与相当高的住院死亡率相关。然而，在这方面，方法回顾性分析1997年至2011年258例因PHH再次剖腹手术的肝癌患者的围手术期资料，并通过单因素和多因素分析进行评价，以确定医院死亡的危险因素。再次剖腹手术后30天，总体死亡率为16.7%。首次识别活动性出血与再次剖腹手术之间的中位时间延迟为6 h（范围0.5-34 h）。接受晚期再次剖腹手术（≥6 h）的患者的死亡率远高于接受早期再次剖腹手术（6 h）的患者（25 vs 8.6%; P = 0.001）。多变量分析显示，（1997-2004年）（P = 0.040），肝硬化（P = 0.025），由于凝血障碍，再次剖腹手术期间止血无效（P = 0.038），晚期再次剖腹手术（≥6 h）（P = 0.032），术后肝功能衰竭（P = 0.001），和需要血液透析的术后急性肾衰竭结论对于肝部分切除术后活动性出血患者，及时再次开腹手术是降低住院死亡率的关键因素。再次剖腹手术后发生急性肝衰竭和/或严重急性肾衰竭的患者应更加小心。
BackgroundPost‐hepatectomy hemorrhage (PHH) requiring re‐laparotomy is a life‐threatening situation and is associated with a considerably high hospital mortality rate. However, risk factors of hospital mortality in patients with this condition have not yet been investigated.MethodsThe perioperative data of 258 patients with hepatocellular carcinoma who underwent re‐laparotomy for PHH from 1997 to 2011 were retrospectively reviewed and evaluated by univariate and multivariate analyses to identify risk factors of hospital mortality.ResultHospital death occurred in 43 patients between 16 h and 40 days after re‐laparotomy, and the overall mortality rate was 16.7 %. The median time lag between first recognition of active bleeding and re‐laparotomy was 6 h (range 0.5–34 h). The mortality of patients undergoing late re‐laparotomy (≥6 h) was much higher than those undergoing early re‐laparotomy (6 h) (25 vs 8.6 %; P = 0.001). Multivariate analysis showed early time period (1997–2004) (P = 0.040), liver cirrhosis (P = 0.025), ineffective hemostasis during re‐laparotomy due to coagulopathy (P = 0.038), late re‐laparotomy (≥6 h) (P = 0.032), postoperative liver failure (P = 0.001), and postoperative acute renal failure requiring hemodialysis (P = 0.024) were independent risk factors of hospital mortality.ConclusionImmediate re‐laparotomy is a key factor to reduce hospital mortality for patients with active bleeding after partial hepatectomy. More care should be taken in those patients who develop acute liver failure and/or serious acute renal failure after re‐laparotomy.
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DOI：
10.1016/s0090-3671(08)79095-5
发表时间：
2008
期刊：
Yearbook of Surgery
影响因子：
--
作者：
T. Eberlein
通讯作者：
T. Eberlein
影响因子：
9
作者：
SITZMANN, JV;GREENE, PS
通讯作者：
GREENE, PS
影响因子：
2.6
作者：
Shirabe, Ken;Kajiyama, Kiyoshi;Maehara, Yoshihiko
通讯作者：
Maehara, Yoshihiko
DOI：
10.1016/j.jamcollsurg.2007.01.035
发表时间：
2007-04-01
影响因子：
5.2
作者：
Taketomi, Akinobu;Kitagawa, Dai;Maehara, Yoshihiko
通讯作者：
Maehara, Yoshihiko
DOI：
--
发表时间：
2008-06
期刊：
Hepatobiliary & pancreatic diseases international : HBPD INT
影响因子：
--
作者：
W. Lau;E. Lai
通讯作者：
W. Lau;E. Lai