Benzoni Enrico, Cojutti Alessandro, Lorenzin Dario, Adani Gian Luigi, Baccarani Umberto, Favero Alessandro, Zompicchiati Aron, Bresadola Fabrizio, Uzzau Alessandro
Department of Surgery, University of Udine, School of Medicine, Udine, Italy.
Langenbecks Arch Surg. 2007 Jan;392(1):45-54. doi: 10.1007/s00423-006-0084-y. Epub 2006 Sep 16.
Notwithstanding technical advances and high experience of liver resection of specialized centers, the rate of complications after surgical resection could be high. In this study, we analyzed causes and foreseeable risk factors linked to postoperative morbidity on the ground of data derived from a single center surgical population.
From September 1989 to March 2005, 134 consecutive patients had liver resection for Hcc and 153 consecutive patients with liver metastasis (derived from either colorectal cancer or noncolorectal cancer) at our department. We performed 22 major hepatectomy, 20 left hepatectomy, 14 trisegmentectomy, 77 bisegmentectomy and/or left lobectomy, 74 segmentectomy, and 80 wedge resection.
In-hospital mortality rate was 4.5%, about 7% in Hcc cases and 2.6% in liver metastasis. Morbidity rate was 47.7%, caused by the rising of ascites (10%), temporary impairment liver function (19%), biliary fistula (6%), hepatic abscess (25%), hemoperitoneum (10%), and pleural effusion (30%) sometimes combined each other. Some variables, associated with the technical aspects of surgical procedure, are responsible of the rising of complication as: Pringle maneuver length of more than 20 minutes (p=0.001); the type of liver resection procedure [major hepatectomy (p=0.02), left hepatectomy (p=0.04), trisegmentectomy (p=0.04), bisegmentectomy and/or left lobectomy (p=0.04)]; and the request of an amount of blood transfusion of more than 600 cc (p=0.04). Also, both liver dysfunction, in particular Child A vs B and C (p=0.01), and histopathological grading (p=0.01) are associated with a high rate of postsurgical complication in Hcc cases.
We make the following recommendations: every liver resection should be planned after intraoperative ultrasonography, anatomical surgical procedure should be preferred instead of wedge resection, and modern devices should be used, like Argon Beam and Ligasure dissector, to reduce the incidence of both intraoperative and postoperative bleeding and biliary leakage.
尽管在肝脏切除手术方面技术不断进步，且专业中心经验丰富，但手术切除后的并发症发生率仍可能较高。在本研究中，我们基于来自单一中心手术人群的数据，分析了与术后发病相关的原因和可预见的风险因素。
从1989年9月至2005年3月，我们科室连续有134例患者因肝癌接受肝脏切除术，153例连续患者因肝转移（源自结直肠癌或非结直肠癌）接受肝脏切除术。我们实施了22例肝大部切除术、20例左肝切除术、14例三段切除术、77例双段切除术和/或左叶切除术、74例段切除术以及80例楔形切除术。
住院死亡率为4.5%，肝癌病例约为7%，肝转移病例为2.6%。发病率为47.7%，由腹水增加（10%）、肝功能暂时受损（19%）、胆瘘（6%）、肝脓肿（25%）、腹腔积血（10%）和胸腔积液（3%）引起，这些情况有时相互合并。一些与手术操作技术方面相关的变量会导致并发症增加，如：Pringle手法持续时间超过20分钟（p = 0.001）；肝脏切除手术类型[肝大部切除术（p = 0.02）、左肝切除术（p = 0.04）、三段切除术（p = 0.04）、双段切除术和/或左叶切除术（p = 0.）]；以及输血需求量超过600 cc（p = 0.04）。此外，肝功能障碍，尤其是Child A与B和C级（p = 0.01）以及组织病理学分级（p = 0.01）在肝癌病例中也与较高的术后并发症发生率相关。
我们提出以下建议：每次肝脏切除术前应进行术中超声检查，应优先选择解剖性手术而非楔形切除术，并应使用现代设备，如氩气刀和结扎速血管闭合系统，以降低术中及术后出血和胆漏的发生率。
