Post-hepatectomy Refractory Ascites in Cirrhotic Patients with Hepatocellular Carcinoma: Risk Factor Analysis to Overcome this Problematic Complication.
Post-hepatectomy Refractory Ascites in Cirrhotic Patients with Hepatocellular Carcinoma: Risk Factor Analysis to Overcome this Problematic Complication.
复制标题
肝硬化合并肝细胞癌患者的肝切除术后难治性腹水：克服这一有问题的并发症的危险因素分析。
作者：
S. Itoh;H. Uchiyama;Y. Ikeda;K. Morita;N. Harada;K. Sugimachi;H. Kawanaka;D. Korenaga;T. Yoshizumi;K. Takenaka;Y. Maehara
背景
顽固性腹水是肝硬变患者肝细胞癌术后的严重并发症。为了避免这一并发症，外科医生在对这类患者施行肝切除术时应尽可能多地保留肝实质。然而，我们仍然偶尔会遇到顽固性腹水，即使在有限的或小的肝切除后。这项研究的目的是确定肝硬变患者肝切除后顽固性腹水的危险因素，重点是有限或小范围的肝切除。
患者和方法
对73例肝硬变合并肝细胞癌患者行有限或小范围肝切除术的资料进行分析。限定或小范围肝切除定义为等于或小于亚段切除的肝切除。我们比较了有和没有术后顽固性腹水的患者的临床病理因素。
结果
14例肝硬变患者术后顽固性腹水。单因素分析发现，总胆固醇、手术时间、Pringle操作时间、切除VII节段、术中失血和术中输血是术后顽固性腹水的显著危险因素。多因素分析显示，切除VII节段是一个独立的危险因素。
结论
切除第七段需要广泛解剖右三角或冠状韧带，这可以解释它是肝切除术后顽固性腹水的独立危险因素。外科医生应避免广泛剥离这些韧带，以避免这种有害的并发症。
BACKGROUND
Refractory ascites is a serious post-hepatectomy complication in cirrhotic patients with hepatocellular carcinoma (HCC). In order to avoid this complication, surgeons should preserve as much liver parenchyma as possible in performing hepatectomy in such patients. However, we still occasionally encounter refractory ascites even after limited or small hepatectomy. The aim of this study was to identify risk factors for post-hepatectomy refractory ascites in cirrhotic patients, focusing on limited or small hepatectomy.
PATIENTS AND METHODS
The data of 73 cirrhotic patients with HCC who underwent limited or small hepatectomy were analyzed. Limited or small hepatectomy was defined as hepatectomy equal to or of less than subsegmentectomy. We compared the clinicopathological factors between patients with and without postoperative refractory ascites.
RESULTS
Fourteen cirrhotic patients suffered postoperative refractory ascites. Total cholesterol, duration of operation, duration of Pringle maneuver, resection of segment VII, intraoperative blood loss, and intraoperative blood transfusion were found to be significant risk factors for postoperative refractory ascites in univariate analyses. Multivariate analysis revealed that resection of segment VII was an independent risk factor.
CONCLUSION
Resection of segment VII necessitates extensive dissection of the right triangular or coronary ligaments, which could explain that it was an independent risk factor for post-hepatectomy refractory ascites. Surgeons should avoid extensive dissection of these ligaments in order to avoid this detrimental complication.
影响因子：
29.4
作者：
El-Serag HB
通讯作者：
El-Serag HB
DOI：
10.1016/s0015-6264(78)80335-6
发表时间：
1986
期刊：
The New Zealand medical journal
影响因子：
--
作者：
D. Woodfield
通讯作者：
D. Woodfield
影响因子：
7
作者：
Tanaka M;Iwakiri Y
通讯作者：
Iwakiri Y