Trends in morbidity and mortality after hepatic resection for hepatocellular carcinoma: An institute's experience with 625 patients
Trends in morbidity and mortality after hepatic resection for hepatocellular carcinoma: An institute's experience with 625 patients
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DOI：
10.1016/j.jamcollsurg.2007.01.035
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发表时间：
2007-04-01
影响因子：
5.2
通讯作者：
Maehara, Yoshihiko
中科院分区：
文献类型：
--
作者：
Taketomi, Akinobu;Kitagawa, Dai;Maehara, Yoshihiko
背景：尽管在围手术期的手术和患者管理方面有了新的进展，但在少数肝切除术的肝细胞癌（HCC）患者中仍然出现了严重的并发症。研究设计：对625例连续行肝切除术的HCC患者进行回顾性研究，并评估手术发病率和死亡率。结果：手术失血量和输血率逐渐降低（p = 0.0001）。腹水和其他并发症的发生率在研究系列中显著降低（p = 0.0001）。医院死亡率和术后肝功能衰竭发生率也分别从2.5%、1.9%（1985年至1990年）、4.4%、3.2%（1991年至1996年）降至1.9%、1.4%（1997年至2002年）。使用多个逻辑回归、独立危险因素与术后并发症被发现的操作(优势比[或]= 0.408;p < 0.0001),丙氨酸转氨酶> = 70 IU / L (OR = 2.020; p = 0.0009)本研究在整个时期(1985 - 2002),或血小板计数< 100 X 10(3) /毫米(3)(OR = 4.654; p = 0.0072)和输血操作期间的存在(OR = 8.249; p = 0.0230)在1997年到2002年。结论：在这个系列中，手术失血量和输血率以及发生主要并发症的患者数量有所下降。这些结果在很大程度上归因于充分选择手术候选人和旨在减少手术失血的因素。[J]中华医学杂志，2007;24(4):558 -587。(C) 2007年由美国外科医师学会发布)。
BACKGROUND:Despite recent developments in surgery and patient management during the perioperative period, critical complications still developed in a few patients who had hepatic resection for hepatocellular carcinoma (HCC).STUDY DESIGN:Six hundred twenty-five consecutive patients who had hepatic resection for HCC were reviewed and operative morbidity and mortality rates assessed.RESULTS:There were progressive decreases in the surgical blood loss and the rate of blood transfusion (p = 0.0001). Occurrence of ascites and other complications dramatically decreased in the study series (p = 0.0001). Hospital death rate and incidence of postoperative liver failure also decreased from 2.5%, 1.9% (1985 to 1990), 4.4%, 3.2% (1991 to 1996) to 1.9%, 1.4% (1997 to 2002), respectively. Using multiple logistic regression, independent risk factors associated with postoperative complications were found to be the period of operation (odds ratio [OR] = 0.408; p < 0.0001) and alanine aminotransferase >= 70 IU/L (OR = 2.020; p = 0.0009) over the entire period of this study (1985 to 2002), or the platelet count of < 100 X 10(3)/mm(3) (OR = 4.654; p = 0.0072) and the presence of blood transfusion during operation (OR = 8.249; p = 0.0230) in 1997 to 2002.CONCLUSIONS:In this series, there has been a decline in surgical blood loss and rate of blood transfusion and in the number of patients with major complications. These results are largely attributable to the adequate selection of surgical candidate and factors aimed at reducing surgical blood loss. (J Am Coll Surg 2007;204:580-587. (C) 2007 by the American College of Surgeons).