A propensity score analysis of two methods of hepatic vascular occlusion in hepatectomy
A propensity score analysis of two methods of hepatic vascular occlusion in hepatectomy
复制标题
肝切除术中两种肝血管闭塞方法的倾向评分分析
DOI：
10.1016/j.jss.2017.02.033
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发表时间：
2017
影响因子：
2.2
通讯作者：
Chen Xiaoping
中科院分区：
文献类型：
--
作者：
Luo Xin;Chen Lin;Liu Wenhua;Dong Shuilin;Luo Hongping;Zhang Bixiang;Chen Xiaoping
肝切除术的关键是减少失血量和保护肝功能。本研究的目的是比较使用两种肝血管流入阻断技术进行部分肝切除术的围手术期结局。材料和方法从我们的中国多机构肝切除数据库中总共选择了1817名患者，并分为两组：半肝入流阻断（HIO）组（n= 1693）和同侧门静脉分支阻断（IPVBO）组（n= 124）。按1：1的比例对患者进行倾向评分匹配。主要结局为术中失血量。次要结果是术后肝功能，术后发病率和死亡率，术后住院时间。ResultsAfter倾向评分匹配，有124例患者在IPVBO组和HIO组，分别。两组患者术中出血量、输血量、手术时间、术后并发症发生率、死亡率、术后住院时间差异均无统计学意义（P> 0.05）。IPVBO组术后ALT峰值明显低于HIO组（P< 0.05）。在术后并发症和死亡率、术后住院时间方面，IPVBO也与HIO相当。因此，IPVBO可能是一种替代的肝流入阻断方法。
BackgroundThe key points in hepatectomy are reducing blood loss and preservation of hepatic function. The aim of this study was to compare the perioperative outcomes of partial hepatectomy using two techniques of hepatic vascular inflow occlusion.Materials and methodsA total of 1817 patients were selected from our multi-institutional hepatectomy database in China and classified into two groups: the hemihepatic inflow occlusion (HIO) group (n= 1693) and the ipsilateral portal vein branch occlusion (IPVBO) group (n= 124). Propensity score matching of patients in a ratio of 1:1 was conducted. The primary outcome was intraoperative blood loss. Secondary outcomes were postoperative liver function, postoperative morbidity and mortality, and duration of hospital stay after surgery.ResultsAfter propensity score matching, there were 124 patients in the IPVBO group and the HIO group, respectively. There were no significant differences between the two groups regarding intraoperative blood loss, blood transfusion requirement, operating time, postoperative morbidity and mortality, and duration of hospital stay after surgery (P> 0.05). However, The IPVBO group was associated with significantly lower peak in postoperative ALT level than the HIO group (P< 0.05).ConclusionsThe results indicated that IPVBO did not lead to more intraoperative blood loss compared with HIO, and it decreased the peak of postoperative ALT level. In terms of postoperative morbidity and mortality, duration of hospital stay after surgery, IPVBO was also equal to HIO. Thus, IPVBO could be an alternative method of hepatic inflow occlusion.