Morphologic severity of cirrhosis determines the extent of liver resection in patients with hepatocellular carcinoma and Child-Pugh grade A cirrhosis.
Morphologic severity of cirrhosis determines the extent of liver resection in patients with hepatocellular carcinoma and Child-Pugh grade A cirrhosis.
复制标题
DOI：
10.1016/j.jss.2015.08.027
复制
发表时间：
2016-02
期刊：
影响因子：
--
通讯作者：
Shao-jun Zhou;E. Zhang;Bin-yong Liang;Zun-yi Zhang;Ke-shuai Dong;P. Hou;Xiao-ping Chen;M. Xiong;Zhiyong Huang
中科院分区：
文献类型：
--
作者：
Shao-jun Zhou;E. Zhang;Bin-yong Liang;Zun-yi Zhang;Ke-shuai Dong;P. Hou;Xiao-ping Chen;M. Xiong;Zhiyong Huang
研究背景肝切除是肝细胞癌和代偿性肝硬化患者的主要治疗手段。我们探讨了肝硬化的形态学严重程度与肝切除术后肝衰竭（PHLF）之间的关系，并评估了肝硬化分期在确定肝切除范围限制中的作用。方法回顾性分析2009年至2013年在同济医院连续672例因肝细胞癌接受根治性肝切除术的Child-Pugh A级肝功能患者的临床病理资料。肝硬化的严重程度通过形态学和组织学进行分期。分析了组织学肝硬化和 PHLF 的危险因素。结合形态学分期研究肝切除范围的限制。结果形态学分期与组织学分期显着相关（τ=0.809，P<0.001）。多变量分析显示，形态学分期是组织学肝硬化（优势比 = 26.99，95% 置信区间 = 16.88–43.14，P< 0.001）和 PHLF（优势比 = 11.48，95% 置信区间 = 6.04–21.82，P< 0.001）的最关键因素。 4个及以上肝段切除后轻度肝硬化患者（13.6%）、大切除后中度肝硬化患者（38.1%）、2个及以上肝段切除后重度肝硬化或重度门脉高压患者（分别为63.2%和50.0%）PHLF发生率较高。结论肝硬化形态严重程度是PHLF的独立预测因素。对于轻度肝硬化患者，切除少于四个肝段是合理的。不建议中度肝硬化患者进行大切除术。对于患有严重肝硬化或严重门静脉高压的患者，只有少于两个肝段的切除才可以安全地进行。
BackgroundLiver resection is the mainstay of treatment for patients with hepatocellular carcinoma and compensated cirrhosis. We investigated the relationship between the morphologic severity of cirrhosis and post-hepatectomy liver failure (PHLF) and evaluated the role of cirrhosis staging in determination of the extent limit for liver resection.MethodsThe clinicopathologic data of 672 consecutive patients with Child–Pugh grade A liver function who underwent curative liver resection for hepatocellular carcinoma in Tongji Hospital from 2009 to 2013 were retrospectively reviewed. Severity of cirrhosis was staged morphologically and histologically. Risk factors for histologic cirrhosis and PHLF were analyzed. The extent limit of liver resection with reference to morphologic staging was studied.ResultsMorphologic and histologic stages were significantly correlated (τ = 0.809,P< 0.001). Multivariate analysis showed that morphologic staging was the most crucial factor for histologic cirrhosis (odds ratio = 26.99, 95% confidence interval = 16.88–43.14,P< 0.001) and PHLF (odds ratio = 11.48, 95% confidence interval = 6.04–21.82,P< 0.001). The incidence of PHLF was high in patients with mild cirrhosis after resection of four or more liver segments (13.6%), those with moderate cirrhosis after major resection (38.1%), and those with severe cirrhosis or severe portal hypertension after resection of two or more liver segments (63.2% and 50.0%, respectively).ConclusionsMorphologic severity of cirrhosis is an independent predictor of PHLF. Resection of fewer than four liver segments is justified in patients with mild cirrhosis. Major resection is not recommended in patients with moderate cirrhosis. In patients with severe cirrhosis or severe portal hypertension, only resection of fewer than two liver segments can be safely performed.