Martin Robert C G, Jarnagin William R, Fong Yuman, Biernacki Peter, Blumgart Leslie H, DeMatteo Ronald P
Hepatobiliary Service, Memorial Sloan-Kettering Cancer Center, Department of Surgery, New York, NY 10021, USA.
J Am Coll Surg. 2003 Mar;196(3):402-9. doi: 10.1016/S1072-7515(02)01752-0.
Major hepatic resection is indicated for selected patients with colorectal metastasis to the liver. Transfusion of fresh frozen plasma (FFP) might be required after major hepatectomy because of blood loss or coagulopathy, but there are no standard criteria for the use of FFP in this setting.
We identified 260 patients from our prospective database who underwent major (> or =3 Couinaud segments) hepatectomy between May 1997 and February 2001 for colorectal metastasis. FFP use was determined and tested for its relationship to clinical and pathologic factors. A survey on FFP use was sent to 12 other hepatobiliary centers worldwide.
There were 142 (55%) men, 118 (45%) women, and the median age was 63 years. The most common hepatic resections performed were right lobectomy (37%) and extended right lobectomy (33%). There were 83 (32%) patients who received FFP. In these patients, a total of 405 units of FFP were administered with a median of 4 units. The majority of patients who received FFP were transfused within the first two postoperative days, while there were only five (2%) patients who initially received FFP beyond that time. FFP was administered for a median prothrombin time of 16.9. Only one (0.4%) patient required reoperation for bleeding. Right lobectomy and extended right lobectomy were found to predict FFP use on multivariate analysis. Postoperative complications did not correlate with FFP use. The criteria used for FFP administration at other major hepatobiliary centers were found to be variable.
There is no universal standard for FFP use following major hepatic resection for colorectal metastasis. Our criterion of a prothrombin time of 16-18 seconds is conservative but results only rarely in reoperation for bleeding. Prospective evaluation of a higher threshold for FFP administration, such as an International Normal Ratio of 2.0, should be performed to better define the guidelines for FFP use in patients undergoing major hepatectomy who have normal underlying hepatic parenchyma.
对于部分发生肝转移的结直肠癌患者，需进行大范围肝切除术。由于失血或凝血功能障碍，大范围肝切除术后可能需要输注新鲜冰冻血浆（FFP），但目前对于在此种情况下使用FFP尚无标准规范。
我们从前瞻性数据库中筛选出1997年5月至2001年2月期间因结直肠癌肝转移接受大范围（≥3个Couinaud肝段）肝切除术的260例患者。确定FFP的使用情况，并检测其与临床及病理因素的关系。同时向全球其他12个肝胆中心进行了关于FFP使用情况的调查。
患者中男性142例（55%），女性118例（45%），中位年龄63岁。最常施行的肝切除术为右半肝切除术（37%）和扩大右半肝切除术（33%）。83例（32%）患者接受了FFP输注。这些患者共输注FFP 405单位，中位输注量为4单位。大多数接受FFP输注的患者在术后前两天内接受了输血，仅有5例（2%）患者在术后两天后才开始接受FFP输注。FFP输注时的凝血酶原时间中位值为16.9。仅1例（0.4%）患者因出血需要再次手术。多因素分析显示，右半肝切除术和扩大右半肝切除术是FFP使用的预测因素。术后并发症与FFP的使用无关。其他主要肝胆中心使用FFP的标准各不相同。
对于结直肠癌肝转移患者进行大范围肝切除术后，FFP的使用尚无统一标准。我们以凝血酶原时间为16 - 18秒作为标准较为保守，但因出血而再次手术的情况很少发生。应进行前瞻性评估，以确定更高的FFP输注阈值，如国际标准化比值为2.0，从而更好地明确对于肝实质正常的大范围肝切除患者使用FFP的指导原则。
