Risk Factors for Massive Bleeding during Major Hepatectomy
Risk Factors for Massive Bleeding during Major Hepatectomy
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DOI：
10.1007/s00268-010-0495-3
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发表时间：
2010-07-01
影响因子：
2.6
通讯作者：
Maehara, Yoshihiko
中科院分区：
文献类型：
--
作者：
Shirabe, Ken;Kajiyama, Kiyoshi;Maehara, Yoshihiko
背景：肝切除术中大出血是死亡率和发病率的危险因素。我们检查了大出血的危险因素及其与预后的相关性。方法采用回顾性病例系列研究。在353例连续肝切除术患者中，平均估计失血量（EBL）为825 ml。10例患者（2.8%）的EBL在3000至5000 ml之间。5例患者（1.4%）出现大量EBL，定义为超过5000 ml，所有5例患者均因原发性肝癌（PLC）接受了右大肝切除术（RMH）。所有行RMH的PLC患者分为两组：1组EBL 5000 ml （n = 5）。比较两组大出血围手术期因素及手术死亡率和发病率。结果10例EBL在3000 ~ 5000ml之间的患者中，3例行尾状叶下腔旁部分不超过肝段亚段的部分切除，3例行中枢性半段切除。1组平均肿瘤大小为7.9 +/- 4.7 cm， II组平均肿瘤大小为15.1 +/- 2.2 cm （P = 0.0034）。II组患者CT扫描均可见肿瘤压迫下腔静脉（IVC），而1组无肿瘤压迫（P < 0.0001）。II组5例患者中有4例通过前路手术。I组19例患者中有14例（74%）采用吊肝手法（LHM）， II组不能采用（P = 0.0059）。II组无术后和住院死亡，两组之间的死亡率和发病率无显著差异。结论大肝癌的RMH、肿瘤压迫下腔静脉和前路无LHM是肝切除术中大出血的危险因素。在这些病例中，有必要准备快速输液器，以避免长期低血压。
Background Massive bleeding during hepatectomy is a risk for mortality and morbidity. We examined the risk factors for massive bleeding and their correlations with outcomes.Methods The study was a retrospective case series. Among 353 consecutively hepatectomizecl patients, the mean estimated blood loss (EBL) was 825 ml. Ten patients (2.8%) experienced EBL of between 3000 and 5000 ml. Five patients (1.4%) experienced massive EBL defined as more than 5000 ml, and all five patients had undergone right major hepatectomy (RMH) for primary liver cancer (PLC). All the patients with PLC who underwent RMH were divided into two groups: group 1 with EBL 5000 ml (n = 5). Perioperative factors regarding massive bleeding and operative mortality and morbidity were compared between the two groups.Results Among the ten patients who experienced EBL of between 3000 and 5000 ml, three had partial hepatectomy of no more than subsegmentectomy of the paracaval portion of the caudate lobe and three had central bisegmentectomy. The mean tumor size was 7.9 +/- 4.7 cm in group 1 and 15.1 +/- 2.2 cm in group II (P = 0.0034). Tumor compression of the inferior vena cava (IVC) on CT scans was observed in all patients in group II, but in no patients in group 1 (P < 0.0001). Four of five patients in group II received surgery through an anterior approach. The liver-hanging maneuver (LHM) was applied in 14 of 19 patients (74%) in group I but could not be applied in group II (P = 0.0059). No postoperative and in-hospital mortalities occurred in group II and there were no significant differences in the incidence of mortality and morbidity between the groups.Conclusions RMH for large PLCs, tumor compression of the IVC, and an anterior approach without the LHM are risks for massive bleeding during hepatectomy. Preparation of rapid infusion devices in these cases is necessary to avoid prolonged hypotension.