Robles Ricardo, Marín Caridad, Fernández Juan Angel, Ramírez Pablo, Sánchez-Bueno Francisco, Morales Dolores, Luján Juan Antonio, Abellán Beatriz, Ramírez María, Cascales Pedro, Pérez Domingo, Parrilla Pascual
Servicio de Cirugía, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
Cir Esp. 2005 Jul;78(1):19-27. doi: 10.1016/s0009-739x(05)70879-4.
Liver resection (LR) morbidity and mortality rates have dropped in recent decades. Mortality is now below 5% and morbidity is less than 30%. Our objective was to present a series of 200 LRs without mortality and to analyze the factors that may be related to complications.
Between January 1996 and October 2003, 200 LRs were performed in 177 patients. The most common indication was liver metastases in 123 patients (61.5%), primary malignant liver tumors in 27 patients (13.5%), bile duct tumors in 27 patients (13.5%) and benign disease in 23 patients (11.5%). Fifty-one percent of the resections were performed under hemihepatic vascular control and 49% were resections of central segments, segmentary and atypical resections. We studied the association between morbidity and age, sex, previous comorbidity, liver status, indication for surgery, number of resections, major and minor resections, resection extended to other organs, type of vascular occlusion, transfusion requirements, operating time, length of hospital stay and experience of the surgical team.
There was no postoperative mortality. The morbidity rate was 17.5% (35 patients) and the most common complications were biliary (8%). Morbidity was related to transfusion (transfused patients presented more complications) (P < .001). Transfusion was greater in major resections, the first 100 resections and prolonged operations. Among the segmentary resections the Pringle maneuver reduced transfusion requirements but this difference was not statistically significant. Morbidity decreased in the second 100 resections, without significant differences.
LRs can be performed with low mortality and morbidity. Biliary complications and blood transfusion should be avoided whenever possible.
近几十年来，肝切除术（LR）的发病率和死亡率有所下降。目前死亡率低于5%，发病率低于30%。我们的目标是报告一组200例无死亡病例的肝切除术，并分析可能与并发症相关的因素。
1996年1月至2003年10月期间，对177例患者进行了200例肝切除术。最常见的适应证是123例（61.5%）肝转移瘤、27例（13.5%）原发性恶性肝肿瘤、27例（13.5%）胆管肿瘤和23例（11.5%）良性疾病。51%的切除术在半肝血管控制下进行，49%为中央段、节段性和非典型切除术。我们研究了发病率与年龄、性别、既往合并症、肝脏状况、手术适应证、切除次数、大、小切除术、延伸至其他器官的切除术、血管阻断类型、输血需求、手术时间、住院时间以及手术团队经验之间的关系。
无术后死亡。发病率为17.5%（35例患者），最常见的并发症是胆系并发症（8%）。发病率与输血有关（输血患者出现更多并发症）（P<0.001）。大切除术、前100例切除术和长时间手术中的输血量更大。在节段性切除术中，Pringle手法减少了输血需求，但这种差异无统计学意义。后100例切除术中发病率降低，但差异无统计学意义。
肝切除术可在低死亡率和发病率的情况下进行。应尽可能避免胆系并发症和输血。
