Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Ann Surg. 2009 Dec;250(6):922-8. doi: 10.1097/SLA.0b013e3181b977a5.
The outcome of hepatic resection in cirrhotic patients has improved remarkably in recent years with improved surgical techniques and perioperative care; however, the role of portal hypertension is still uncertain. The aim of this study was to elucidate surgical outcomes of hepatectomy in patients with portal hypertension.
Data from 241 cirrhotic patients who underwent resection for hepatocellular carcinoma were retrospectively collected and analyzed: patients were divided into 2 groups according to the presence (n = 89) or absence (n = 152) of portal hypertension at the time of surgery. To overcome biases owing to the different distribution of covariates throughout the 2 groups, a one-to-one match was created using propensity score analysis: after match, intraoperative, and postoperative course and survival rates were analyzed.
Patients with portal hypertension experienced worse preoperative liver function (mean model for end-stage liver disease [MELD] score, 9.5 +/- 7.8 vs. 8.4 +/- 1.3; P = 0.001) and survival rates (P = 0.008) in comparison to those without portal hypertension: after one-to-one matching, patients with (n = 78) and without portal hypertension (n = 78) had the same preoperative characteristics and showed the same intraoperative course, postoperative occurrence of liver failure, morbidity, length of in-hospital stay and survival rates (P = ns in all cases). The only predictors of postoperative liver failure were MELD score (P = 0.001) and extent of hepatectomy (P = 0.005).
Faced with the same MELD score and extent of hepatectomy planning, presence of portal hypertension should not be considered as a contraindication for hepatic resection in cirrhotic patients.
近年来，随着外科技术和围手术期护理的进步，肝硬化患者肝切除的预后显著改善，但门静脉高压的作用仍不确定。本研究旨在阐明门静脉高压症患者肝切除的手术结果。
回顾性收集并分析了 241 例因肝细胞癌行切除术的肝硬化患者的数据：根据手术时是否存在门静脉高压（n = 89）将患者分为 2 组。为了克服由于协变量在两组中的分布不同而产生的偏差，使用倾向评分分析创建了一对一匹配：匹配后，分析术中、术后过程和生存率。
与无门静脉高压的患者相比，有门静脉高压的患者术前肝功能更差（平均终末期肝病模型评分，9.5 +/- 7.8 与 8.4 +/- 1.3；P = 0.001）和生存率（P = 0.008）更差：经过一对一匹配，有门静脉高压的患者（n = 78）和无门静脉高压的患者（n = 78）具有相同的术前特征，并且术中过程、术后肝功能衰竭、发病率、住院时间和生存率相同（所有情况下 P = ns）。术后肝功能衰竭的唯一预测因素是 MELD 评分（P = 0.001）和肝切除范围（P = 0.005）。
在面对相同的 MELD 评分和肝切除范围规划时，门静脉高压不应被视为肝硬化患者肝切除的禁忌症。
