Sirichindakul Boonchoo, Chanwat Rawisak, Nonthasoot Bunthoon, Suphapol Jade, Nivatvongs Supanit
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2005 Sep;88 Suppl 4:S54-8.
Hepatic resection is the mainstay treatment of hepatobiliary tumor Nowadays, mortality is less than 6%. However, morbidity is still high. Bleeding is one of the most common problems during hepatic resection which can sometimes lead to catastrophe. The purpose of the present study was to investigate the risk factors associated with major blood loss during hepatic resection for hepatobiliary tumor.
A total of 69 consecutive patients who underwent elective hepatic resection for hepatobiliary tumor from May 2002 to April 2004 were enrolled into this retrospective study. The Patients were divided into 2 groups(group I and II) according to the intraoperative blood loss. Patients who had a blood loss of more than 1000 ml were defined as the major blood loss group(group I). Thirteen variable factors were analyzed to determine the risk of major intraoperative blood loss. Operative outcomes between the two groups were also compared.
Of the sixty-nine patients, 36 patients were in group I and 33 patients were in group II. 75% of the patients in group I and 36.4% of the patients in group II were transfused. Median blood transfusion in group I and II were 3 and 0 units of packed red cell. Univariate analysis showed tumor size, extent of hepatic resection, tumor pathology and operative time were factors affecting major intraoperative blood loss. However, multivariate analysis showed only operative time and tumor size to be independent risk factors. Patients in group I had higher surgical morbidity and prolonged hospital stay compared with patients in group II.
Blood loss is still a major concern in performing hepatic resection. From the present study, tumor size and operative time are the independent factors affecting major intraoperative blood loss. Proper screening or a surveillance program may enhance the chance to find small tumors. Refined operative techniques such as anterior approach and liver hanging would facilitate resection for large right sided tumors.
肝切除术是肝胆肿瘤的主要治疗方法。目前，死亡率低于6%。然而，发病率仍然很高。出血是肝切除术中最常见的问题之一，有时可能导致严重后果。本研究的目的是探讨肝胆肿瘤肝切除术中大出血的相关危险因素。
本回顾性研究纳入了2002年5月至2004年4月期间连续接受择期肝胆肿瘤肝切除术的69例患者。根据术中失血量将患者分为两组（I组和II组）。术中失血量超过1000ml的患者被定义为大出血组（I组）。分析13个可变因素以确定术中大出血的风险。还比较了两组之间的手术结果。
69例患者中，I组36例，II组33例。I组75%的患者和II组36.4%的患者接受了输血。I组和II组的红细胞中位数输血量分别为3单位和0单位。单因素分析显示肿瘤大小、肝切除范围、肿瘤病理和手术时间是影响术中大出血的因素。然而，多因素分析显示只有手术时间和肿瘤大小是独立的危险因素。与II组患者相比，I组患者的手术发病率更高，住院时间更长。
失血仍然是肝切除术中的一个主要问题。从本研究来看，肿瘤大小和手术时间是影响术中大出血的独立因素。适当的筛查或监测计划可能会增加发现小肿瘤的机会。精细的手术技术，如前入路和肝脏悬吊，将有助于右侧大肿瘤的切除。
