Mutsaerts Elar, Zoetmulder Fan, Hart A, van Coevorden F
Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek ziekenhuis, Amsterdam, The Netherlands.
Hepatogastroenterology. 2007 Mar;54(74):458-62.
BACKGROUND/AIMS: The aim of this study was to identify potentially prognostic factors that could predict the morbidity and mortality of liver resection for metastatic cancer.
From January 1990 through December 1999, 136 patients who were treated for liver metastases of all primaries were identified from a prospective database. A stepwise procedure using logistic regression analysis was used to identify prognostic factors.
Postoperative morbidity and mortality were 27% (95% confidence interval: 20-36%) and 2% (95% confidence interval: 0.0-4.0%) respectively. In our series we found the duration of surgery (postoperative complications increasing from 10% for operations of 2 hours or less to 44% for operations of more than 3.5 hours) and perioperative blood transfusion as prognostic factors for postoperative complications in general; we found a specific relation between extended right hemihepatectomy and postoperative bile duct related problems.
Elective hepatic surgery is safe, irrespective of its extent. The importance of technical measures to prevent blood loss and bile leakage has to be underlined. No perioperative factor could be determined to be exclusionary when considering a patient for resection.
背景/目的：本研究旨在确定可能预测转移性癌肝切除术后发病率和死亡率的潜在预后因素。
从1990年1月至1999年12月，从一个前瞻性数据库中确定了136例接受各种原发癌肝转移治疗的患者。采用逻辑回归分析的逐步程序来确定预后因素。
术后发病率和死亡率分别为27%（95%置信区间：20 - 36%）和2%（95%置信区间：0.0 - 4.0%）。在我们的系列研究中，我们发现手术时间（术后并发症从2小时或更短时间手术的10%增加到超过3.5小时手术的44%）和围手术期输血是一般术后并发症的预后因素；我们发现扩大右半肝切除术与术后胆管相关问题之间存在特定关系。
选择性肝脏手术是安全的，无论其范围如何。必须强调预防失血和胆漏的技术措施的重要性。在考虑患者进行切除时，没有围手术期因素可被确定为排除标准因素。
