Konopke Ralf, Kersting Stephan, Bunk Alfred, Dietrich Janine, Denz Axel, Gastmeier Jörg, Saeger Hans-Detlev
Department of General, Thoracic, and Vascular Surgery, University of Dresden, Dresden, Germany.
Int J Colorectal Dis. 2009 Jun;24(6):687-97. doi: 10.1007/s00384-009-0669-3. Epub 2009 Feb 13.
BACKGROUND/AIMS: Despite advances in diagnosis and treatment, the rate of complications after resection for colorectal liver metastases remains high. An awareness of risk factors is essential for the rates of morbidity and mortality to fall to optimal levels.
Of the 240 patients who underwent resection for the first manifestation of colorectal liver metastases, 49 patients with lobectomy or extended hepatectomy (major resections) and 58 with wedge resections within only one liver segment (minor resections) form the basis of this report. A total of 16 variables were analyzed to find the risk factors linked to postoperative morbidity and mortality.
RESULTS/FINDINGS: Thirty-four patients (31.8%) suffered postoperative complications, and one patient died during the hospital stay (0.9%). In the major resection group, multivariate analysis showed that neoadjuvant chemotherapy [odds ratio (OR): 2.4; p = 0.005], vascular clamping (OR: 1.4; p = 0.008), and intraoperative blood loss with transfusion of three to six packed red cell units (OR: 1.2; p = 0.029) were significantly associated with postoperative morbidity. Vascular clamping was an independent predictor for biliary fistula (OR: 1.2; p = 0.029). Postoperative temporary liver failure was influenced by neoadjuvant chemotherapy (OR: 3.4; p = 0.010), vascular clamping (OR: 1.5; p = 0.015), and requirement of blood transfusion (OR: 2.1; p = 0.016). After minor resections, only a decreased postoperative serum cholinesterase B level was an independent predictor for complications (OR: 2.2; p = 0.001), as well as for hemorrhage (OR: 1.6; p = 0.023). Postoperative mortality was not predicted by any of the factors that were analyzed.
INTERPRETATION/CONCLUSION: Factors for complications differ depending on the extent of colorectal liver metastasis resection. Only knowledge and particular consideration of these factors may provide for an optimal postoperative outcome for the individual patient.
背景/目的：尽管在诊断和治疗方面取得了进展，但结直肠癌肝转移切除术后的并发症发生率仍然很高。了解危险因素对于将发病率和死亡率降至最佳水平至关重要。
在240例因首次出现结直肠癌肝转移而接受手术切除的患者中，49例行肝叶切除术或扩大肝切除术（大手术），58例行仅一个肝段内的楔形切除术（小手术），构成了本报告的基础。共分析了16个变量，以找出与术后发病率和死亡率相关的危险因素。
结果/发现：34例患者（31.8%）出现术后并发症，1例患者在住院期间死亡（0.9%）。在大手术组中，多因素分析显示新辅助化疗[比值比（OR）：2.4；p = 0.005]、血管钳夹（OR：1.4；p = 0.008）以及术中失血并输注三至六个单位浓缩红细胞（OR：1.2；p = 0.029）与术后并发症显著相关。血管钳夹是胆瘘的独立预测因素（OR：1.2；p = 0.029）。术后暂时性肝衰竭受新辅助化疗（OR：3.4；p = 0.010）、血管钳夹（OR：1.5；p = 0.015）和输血需求（OR：2.1；p = 0.016）的影响。小手术后，仅术后血清胆碱酯酶B水平降低是并发症（OR：2.2；p = 0.001）以及出血（OR：1.6；p = 0.023）的独立预测因素。术后死亡率无法通过所分析的任何因素预测。
解读/结论：结直肠癌肝转移切除范围不同，并发症的相关因素也不同。只有了解并特别考虑这些因素，才能为个体患者提供最佳的术后结果。
