Aldrighetti Luca, Arru Marcella, Calori Giliola, Caterini Roberto, Comotti Laura, Torri Giorgio, Ferla Gianfranco
Department of Surgery, Scientific Institute San Raffaele Hospital, Vita-Salute San Raffaele University School of Medicine, 20132 Milan, Italy.
Am Surg. 2004 May;70(5):453-60.
The purpose of this study was to evaluate the influence of age on the outcome of liver resections. One hundred five consecutive hepatic resections were divided into two groups: > or = 65 years old [old group (O-group)] and < 65 years old [young group (Y-group)]. The two groups were first compared to evaluate the distribution of the variables potentially affecting the postoperative course, including primary diagnosis, concomitant diseases, previous upper abdominal surgery, type of operation (major or minor resection), associated procedures, presence and length of portal clamping, intraoperative blood losses and transfusions, and length of operation. The outcome of hepatic resections in the two groups was comparatively evaluated in terms of postoperative mortality, morbidity, transfusions, and length of postoperative hospitalization. The Y-group included 61 resections in 60 patients, mean age 52 +/- 10 years (mean +/- SD), range 23-64 years, whereas the O-group included 44 resections in 43 patients, mean age 71 +/- 4 years (mean +/- SD ), range 65-82 years. The O-group included more hepatocellular carcinomas (45.4% vs 18.0%, P = 0.002) and chronic liver diseases (40.9% vs 18.7%, P = 0.017); the median length of operation was slightly higher in the Y-group (300 minutes vs 270 minutes, P = 0.003). Both O-group and Y-group were comparable (P = n.s.) when evaluated for all other listed variables. As far as concerns the outcome of hepatic resections in the two groups, the length of postoperative hospitalization was identical (median 9 days, 5-60 days), whereas transfusions of packed red cells (O-group vs Y-group: 25.0% vs 16.3%, P = 0.30) or fresh frozen plasma (O-group vs Y-group: 13.6% vs 6.5%, P = 0.053) were not statistically different. Postoperative mortality included one case among young patients whereas no deaths were recorded among elderly patients. Postoperative morbidity was higher in Y-group than in O-group (31.5% vs 20.5%, P = 0.59). The age factor does not negatively affect the outcome of liver resections.
本研究的目的是评估年龄对肝切除手术结果的影响。连续105例肝切除术被分为两组:≥65岁[老年组(O组)]和<65岁[青年组(Y组)]。首先比较两组,以评估可能影响术后病程的变量分布,包括初始诊断、伴随疾病、既往上腹部手术史、手术类型(大手术或小手术切除)、相关操作、门静脉阻断的存在及时间、术中失血量及输血量以及手术时长。从术后死亡率、发病率、输血量及术后住院时长方面对两组肝切除手术的结果进行比较评估。Y组包括60例患者的61例切除术,平均年龄52±10岁(平均±标准差),范围23 - 64岁,而O组包括43例患者的44例切除术,平均年龄71±4岁(平均±标准差),范围65 - 82岁。O组肝细胞癌更多(45.4%对18.0%,P = 0.002)且慢性肝病更多(40.9%对18.7%,P = 0.017);Y组手术中位时长略长(300分钟对270分钟,P = 0.003)。评估所有其他列出的变量时,O组和Y组具有可比性(P = 无显著差异)。就两组肝切除手术的结果而言,术后住院时长相同(中位9天,5 - 60天),而浓缩红细胞输血(O组对Y组:25.0%对16.3%,P = 0.30)或新鲜冰冻血浆输血(O组对Y组:13.6%对6.5%,P = 0.053)无统计学差异。术后死亡病例中年轻患者有1例,而老年患者无死亡记录。Y组术后发病率高于O组(31.5%对20.5%,P = 0.59)。年龄因素不会对肝切除手术结果产生负面影响。