Posthepatectomy Portal Vein Pressure Predicts Liver Failure and Mortality after Major Liver Resection on Noncirrhotic Liver
Posthepatectomy Portal Vein Pressure Predicts Liver Failure and Mortality after Major Liver Resection on Noncirrhotic Liver
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DOI：
10.1097/sla.0b013e3182a64b38
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发表时间：
2013-11-01
影响因子：
9
通讯作者：
Vibert, Eric
中科院分区：
文献类型：
--
作者：
Allard, Marc-Antoine;Adam, Rene;Vibert, Eric
目的：评估肝大部切除术后门静脉压力（PVP）对无肝硬化患者术后肝功能衰竭（PLF）和90天死亡率的预测价值。背景：由于PVP升高与活体肝移植后肝功能衰竭相关，我们假设肝大部切除术后的结果可能受术后PVP的影响。纳入了所有无严重纤维化或肝硬化、接受了大肝切除术（>= 3个肝段）并在手术结束时进行了PVP术中测量的患者。根据3种最广泛使用的PLF定义分析结局：“50-50”标准、血清胆红素峰值大于120 μ mol/L和国际肝脏外科研究组（ISGLS）提出的C级PLF。采用受试者工作特征曲线和Logistic回归模型确定PVP的最佳临界值和PLF的独立危险因素。术后PVP与PLF风险逐渐相关。当PVP为10 mm Hg或更低时，PLF的概率为零，当PVP为20 mm Hg时，范围为13%至16%，当PVP为30 mm Hg时，范围为24%至33%，具体取决于PLF的定义。当考虑到“50-50”标准和C级PLF（由国际肝脏外科研究组提出）时，术后PVP预测PLF的最佳值为22 mm Hg。21 mm Hg的值最能预测PLF，其定义为血清胆红素峰值大于120 μ mol/L和90天死亡率。在多变量分析中，术后PVP仍然是PLF的独立预测因素，以及切除范围、术中输血和糖尿病的存在。90天的死亡率与PVP大于21毫米汞柱，年龄大于70岁，术中transfusion.Conclusions：术后PVP是一个独立的预测因素PLF和90天的死亡率后，主要肝切除术无肝硬化患者。当PVP超过20 mm Hg时，建议术中调整PVP。
Objectives: To evaluate the predictive value of portal vein pressure (PVP) after major liver resection for posthepatectomy liver failure (PLF) and 90-day mortality in patients without cirrhosis.Background: As elevated PVP is associated with liver failure after living donor liver transplantation, we hypothesized that the outcome after major hepatectomy may be influenced by posthepatectomy PVP.Patients and Methods: All patients without severe fibrosis or cirrhosis who underwent a major liver resection (>= 3 segments) with an intraoperative measurement of PVP at the end of the procedure were included. Outcome was analyzed regarding 3 most widely used definitions of PLF: "50-50" criteria, peak of serum bilirubin greater than 120 mu mol/L, and grade C PLF proposed by the International Study Group of Liver Surgery (ISGLS). Receiver operating characteristic curves and logistic regression model were used to determine the optimal cutoff of PVP and independent risk factors of PLF.Results: The study population consisted of 277 patients. Posthepatectomy PVP was gradually correlated with the PLF risk. Probability for PLF was nil when PVP was 10 mm Hg or less, ranges from 13% to 16%, depending on PLF definitions, when PVP was 20 mm Hg, and from 24% to 33% when PVP was 30 mm Hg. The optimal value of posthepatectomy PVP to predict PLF was 22 mm Hg when considering the "50-50" criteria and grade C PLF (proposed by the International Study Group of Liver Surgery). A value of 21 mm Hg best predicted PLF defined by peak of serum bilirubin greater than 120 mu mol/L and 90-day mortality. At multivariate analysis, posthepatectomy PVP remained an independent predictor of PLF as well as the extent of resection, intraoperative transfusion, and the presence of diabetes. The 90-day mortality was associated with PVP greater than 21 mm Hg, older than 70 years, and intraoperative transfusion.Conclusions: Posthepatectomy PVP is an independent predictive factor of PLF and of 90-day mortality after major liver resection in patients without cirrhosis. Intraoperative modulation of PVP would be advisable when PVP exceeds 20 mm Hg.