One thousand fifty-six hepatectomies without mortality in 8 years
One thousand fifty-six hepatectomies without mortality in 8 years
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DOI：
10.1001/archsurg.138.11.1198
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发表时间：
2003-11-01
影响因子：
--
通讯作者：
Makuuchi, M
中科院分区：
文献类型：
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作者：
Imamura, H;Seyama, Y;Makuuchi, M
背景资料：尽管在诊断和手术技术的改进，手术死亡率与肝切除术仍大于2%.Hypothesis：通过完善术前和术后护理和手术技巧，肝切除术死亡率可以降低到零。设计：回顾性队列研究，分析1056例连续肝切除术的术后发病率和死亡率。8年。设置：三级转诊中心。共有915例患者接受了1056次连续肝切除术：532例肝细胞癌，262例其他原发性和继发性肝脏恶性肿瘤，57例胆道恶性肿瘤，174例活体肝移植，31例其他良性疾病。主要结果测量：手术死亡率和发病率。根据术后放射学或手术干预定义，3%的肝细胞癌患者、8%的其他肝脏恶性肿瘤患者、28%的胆道恶性肿瘤患者和5%的活体肝移植供体发生了严重并发症。使用多元逻辑回归，与主要并发症相关的独立风险因素包括肝细胞癌手术失血量1000 mL或以上、总胆红素水平1.0 mg/dL或以上（大于或等于17 mumol/L）以及手术时间超过6小时对于其他肝脏恶性肿瘤。在本研究的变量中，没有发现与胆道恶性肿瘤或活体肝移植供体的主要并发症相关的独立因素。肝切除术可以在没有死亡率的情况下进行，前提是它是在一个高容量的医疗中心进行的，经过培训的肝胆外科医生非常关注肝脏储备功能与待切除肝脏体积之间的平衡。
Background: Despite improvements in diagnostic and surgical techniques, operative mortality associated with liver resection is still greater than 2% in most of the recent studies.Hypothesis: By refining preoperative and postoperative care and surgical skills, liver resection mortality can be decreased to zero.Design: Retrospective cohort study to analyze postoperative morbidity and mortality in 1056 consecutive hepatectomies performed at a single medical center during 8 years.Setting: Tertiary referral center.Patients: A total of 915 patients who underwent 1056 consecutive hepatic resections: 532 for hepatocellular carcinoma, 262 for other primary and secondary liver malignancies, 57 for biliary tract malignancy, 174 for living donor liver transplantation, and 31 for other benign diseases.Main Outcome Measures: Operative mortality and morbidity rates.Results: No operative mortality occurred. Major complications, as defined by postoperative radiologic or surgical intervention, occurred in 3% of patients with hepatocellular carcinoma, 8% with other liver malignancy, 28% with biliary malignancy, and 5% of living donor liver transplantation donors. Using multiple logistic regression, independent risk factors associated with major complications were operative blood loss of 1000 mL or greater for hepatocellular carcinoma and total bilirubin level of 1.0 mg/dL or greater (greater than or equal to 17 mumol/L) and operative time greater than 6 hours for other liver malignancy. No independent factors associated with major complications were identified for biliary malignancy or for living donor liver transplantation donors among the variables investigated in this study.Conclusions: Liver resection can be performed without mortality provided that it is carried out in a high-volume medical center by well-trained hepatobiliary surgeons paying meticulous attention to the balance between the liver functional reserve and the volume of liver to be removed.