Is radical hepatic surgery safe?
Is radical hepatic surgery safe?
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DOI：
10.1016/s0002-9610(97)00265-1
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发表时间：
1998-02-01
影响因子：
3
通讯作者：
Habib, N
中科院分区：
文献类型：
--
作者：
Brancatisano, R;Isla, A;Habib, N
背景技术背景：对1989年至1995年在Hammersmith医院进行的200例良性和恶性疾病的连续肝切除术进行了前瞻性回顾，以评估根治性肝切除术的安全性。肝细胞癌（n = 39），胆管癌（n = 21），胆囊癌（n = 8），结直肠继发性癌（n = 75），非结直肠继发性癌（n = 35），良性病变26例。20例患者患有黄疸，36例患者患有黄疸。74%的病例进行了大切除术，包括63例扩大肝切除术，17例复发性结直肠转移的重复切除术，17例切除联合血管重建。大部分病例采用全肝血管阻断术。结果：总死亡率为5%。30天死亡率为2.5%。败血症而不是出血是最常见的死亡原因。有101例并发症发生在37%的患者中。主要并发症为膈下脓肿和胆漏。肝切除的范围（主要与次要）显着增加发病率的风险（46%对16%）。失血量大于100 mt时，发病风险从12%增加到25%。结论：肝大部切除术的死亡率可以接受，但发病率较高。(C)1998年，Excerpta Medica，Inc.
BACKGROUND: A prospective review of 200 consecutive liver resections performed for benign and malignant disease, between 1989 and 1995 at the Hammersmith Hospital, was undertaken to evaluate the safety of radical hepatic resection.METHODS: The indications for operation were: hepatocellular carcinoma (n = 39), cholangiocarcinoma (n = 21), gall bladder carcinoma (n = 8), colorectal secondaries (n = 75), noncolorectal secondaries (n = 35), and benign disease (n = 26). Twenty patients were cirrhotic and 36 were jaundiced. Major resections were performed in 74% of cases and included 63 extended hepatectomies, 17 repeated resections for recurrent colorectal metastases, and 17 resections combined with vascular reconstruction. Total vascular exclusion of the liver was used in the majority of cases.RESULTS: The overall mortality rate was 5%. Thirty-day mortality was 2.5%. Sepsis and not hemorrhage was the most common cause of death. There were 101 complications that occurred in 37% of the patients. The main complications were subphrenic abscess and biliary leak. The extent of liver resection (major versus minor) significantly increased the risk of morbidity (46% versus 16%). Blood loss greater than 100 mt increased the risk of morbidity from 12% to 25%.CONCLUSIONS: Major hepatic resection can be achieved with acceptable mortality but high morbidity rates. (C) 1998 by Excerpta Medica, Inc.