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肝良性病变的肝切除术:827例连续病例的回顾性分析

Liver resection for benign hepatic lesions: a retrospective analysis of 827 consecutive cases.

作者信息

Feng Zhi-Qiang, Huang Zhi-Qiang, Xu Li-Ning, Liu Rong, Zhang Ai-Qun, Huang Xiao-Qiang, Zhang Wen-Zhi, Dong Jia-Hong

机构信息

Department of Hepatobiliary Surgery, General Hospital of PLA, 28 Fuxing Rd. Haidian District, Beijing 100853, China.

出版信息

World J Gastroenterol. 2008 Dec 21;14(47):7247-51. doi: 10.3748/wjg.14.7247.

Abstract

AIM

To analyze the operative and perioperative factors associated with hepatectomy of benign hepatic lesions.

METHODS

A total of 827 consecutive cases of benign hepatic lesion undergoing hepatectomy from January 1986 to December 2005 in the Chinese PLA General Hospital were investigated retrospectively according to their medical documentation.

RESULTS

The effect of operative and perioperative factors on the outcome of patients were analyzed. Of the 827 cases undergoing hepatectomy for more than 3 liver segments accounted for 22.1%, 316 (38.21%) required transfusion of blood products during operation. The average operating time was 220.59 +/- 109.13 min, the average hospital stay after operation was 13.55 +/- 9.38 d. Child-Pugh A accounted for 98.13%. The postoperative complication rate was 13.54% and the in-hospital mortality rate was 0.24%. Multivariate analysis showed that operating time (P = 0.004, OR = 1.003) and albumin value (P = 0.040, OR = 0.938) were the independent predictors of morbidity and indicated that operating time, blood transfusion, complication rate, and LOS had a trend to decrease.

CONCLUSION

Hepatectomy for benign hepatic lesions can be performed safely with a low morbidity and mortality, provided that it is carried out with optimized perioperative management and an innovative surgical technique.

摘要

目的

分析与良性肝病变肝切除术相关的手术及围手术期因素。

方法

回顾性调查1986年1月至2005年12月在中国人民解放军总医院连续接受肝切除术的827例良性肝病变患者的病历资料。

结果

分析手术及围手术期因素对患者预后的影响。827例肝切除术中,超过3个肝段切除的占22.1%,316例(38.21%)术中需要输注血液制品。平均手术时间为220.59±109.13分钟,术后平均住院时间为13.55±9.38天。Child-Pugh A级占98.13%。术后并发症发生率为13.54%,院内死亡率为0.24%。多因素分析显示,手术时间(P = 0.004,OR = 1.003)和白蛋白值(P = 0.040,OR = 0.938)是发病的独立预测因素,并表明手术时间、输血、并发症发生率和住院时间有下降趋势。

结论

只要采用优化的围手术期管理和创新的手术技术,良性肝病变肝切除术可以安全进行,发病率和死亡率较低。

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