Cescon Matteo, Vetrone Gaetano, Grazi Gian Luca, Ramacciato Giovanni, Ercolani Giorgio, Ravaioli Matteo, Del Gaudio Massimo, Pinna Antonio Daniele
Liver and Multiorgan Transplant Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Ann Surg. 2009 Jun;249(6):995-1002. doi: 10.1097/SLA.0b013e3181a63c74.
To estimate risk factors affecting the early outcome after hepatic resection in a high volume center specialized in hepatobiliary surgery and to analyze the changing of results during 3 different periods of treatment.
Retrospective review.
A series of 1500 consecutive patients who underwent hepatic resection.
Postoperative morbidity and mortality were analyzed in relation to indications for surgery, period of operation, patient characteristics, and intraoperative variables. Patients were classified into 4 groups, according to the indication for surgery: primary liver tumors with cirrhosis (group 1, G1); other liver malignancies (group 2, G2); biliary malignancies (group 3, G3); and benign diseases (group 4, G4). Patients were also divided into 3 groups, according to the year of operation (period 1: June 1985 to October 1993; period 2: November 1993 to September 1999; period 3: October 1999 to September 2007).
Overall mortality and morbidity were 3% and 22.5%, respectively. Multivariate analysis revealed that blood transfusions, G1, and additional procedures were associated with an increased risk of postoperative complications, whereas blood transfusions, G1, G3, and extended hepatectomy were associated with an increased risk of postoperative mortality. G1 decreased, whereas G3, extended hepatectomies and additional procedures significantly increased between periods 2 and 3 (P < 0.05). The complication rate was significantly lower in period 2 (18.8%) compared with period 1 (23.8%) and period 3 (24.8%). Similarly, there was a significantly lower mortality rate in period 2 (1.6%) compared with period 1 (3.4%) and period 3 (4%).
Slightly worse short-term outcomes in liver surgery were observed in recent years, with a concomitant increase of the aggressiveness of operative strategies. Nevertheless, the present results still justify an aggressive approach in liver resections.
评估在一家大型肝胆外科中心影响肝切除术后早期结局的危险因素，并分析三个不同治疗时期结果的变化情况。
回顾性研究。
连续1500例行肝切除术的患者。
分析术后发病率和死亡率与手术指征、手术时期、患者特征及术中变量的关系。根据手术指征，患者被分为4组：肝硬化原发性肝肿瘤（第1组，G1）；其他肝脏恶性肿瘤（第2组，G2）；胆管恶性肿瘤（第3组，G3）；良性疾病（第4组，G4）。根据手术年份，患者也被分为3组（时期1：1985年6月至1993年10月；时期2：1993年11月至1999年9月；时期3：1999年10月至2007年9月）。
总体死亡率和发病率分别为3%和22.5%。多因素分析显示，输血、G1组和附加手术与术后并发症风险增加相关，而输血、G1组、G3组和扩大肝切除术与术后死亡风险增加相关。在时期2和时期3之间，G1组减少，而G3组、扩大肝切除术和附加手术显著增加（P<0.05）。时期2的并发症发生率（18.8%）显著低于时期1（23.8%）和时期3（24.8%）。同样，时期2的死亡率（1.6%）显著低于时期1（3.4%）和时期3（4%）。
近年来肝手术的短期结局略差，同时手术策略的激进程度有所增加。尽管如此，目前的结果仍证明肝切除术采用积极的方法是合理的。
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