Capussotti L, Viganò L, Giuliante F, Ferrero A, Giovannini I, Nuzzo G
Department of Hepatopancreatobiliary and Digestive Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, Turin, Italy.
Br J Surg. 2009 Jan;96(1):88-94. doi: 10.1002/bjs.6429.
Liver failure is the principal cause of death after hepatectomy. Its progression towards death and its relationship with sepsis are unclear. This study analysed predictors of mortality in patients with liver dysfunction and the role of sepsis in the death of these patients.
The study focused on patients with liver dysfunction, excluding those with vascular thrombosis, after liver resection at one of two centres between 1998 and 2006.
Liver dysfunction occurred after 57 (4.5 per cent) of 1271 hepatectomies. Fifty-three patients without vascular thrombosis were included in the analysis, with a mortality rate of 23 per cent. Independent predictors of death were age (odds ratio (OR) 1.18 per year increase; P = 0.017), cirrhosis (OR 54.09; P = 0.004) and postoperative sepsis (OR 37.58; P = 0.005). Sepsis occurred in 15 patients (28 per cent), seven of whom died. Intestinal pathogens were isolated in 12 patients with sepsis. The risk of sepsis was significantly increased in those with surgical complications (11 of 16 versus four of 37; P < 0.001).
Sepsis plays a key role in the death of patients with liver dysfunction after hepatectomy. Early recognition and aggressive treatment of sepsis may reduce mortality.
肝衰竭是肝切除术后的主要死亡原因。其向死亡的进展及其与脓毒症的关系尚不清楚。本研究分析了肝功能不全患者的死亡预测因素以及脓毒症在这些患者死亡中的作用。
该研究聚焦于1998年至2006年间在两个中心之一接受肝切除术后出现肝功能不全的患者，排除有血管血栓形成的患者。
1271例肝切除术中，57例（4.5%）出现肝功能不全。53例无血管血栓形成的患者纳入分析，死亡率为23%。死亡的独立预测因素为年龄（每年增加的比值比（OR）为1.18；P = 0.017）、肝硬化（OR 54.09；P = 0.004）和术后脓毒症（OR 37.58；P = 0.005）。15例患者（28%）发生脓毒症，其中7例死亡。12例脓毒症患者分离出肠道病原体。有手术并发症的患者发生脓毒症的风险显著增加（16例中有11例，37例中有4例；P < 0.001）。
脓毒症在肝切除术后肝功能不全患者的死亡中起关键作用。早期识别和积极治疗脓毒症可能降低死亡率。
