Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.
Pancreatology. 2011;11(1):24-9. doi: 10.1159/000323961. Epub 2011 Feb 18.
BACKGROUND/AIMS: Pancreatic surgery is associated with an increased risk of postoperative complications. We therefore investigated the impact of an additional liver function disorder on the postoperative outcome using a case-control study of patients with or without liver cirrhosis who underwent pancreatic surgery at our department.
Between 1998 and 2008, 1,649 pancreatic resections were performed. Of these, 32 operations were performed in patients who also suffered from liver cirrhosis (30× Child A, 2× Child B). For our case-control study, we selected another 32 operated patients without cirrhosis who were matched according to age, sex, diagnosis and tumor classification. The following parameters were compared between both groups: operating time, number of transfusions, duration of ICU and hospital stay, incidence of complications, rate of reoperation, mortality.
Patients with cirrhosis experienced complications significantly more often (69 vs. 44%; p = 0.044), especially major complications (47 vs. 22%; p = 0.035) requiring reoperation (34 vs. 12%; p = 0.039). These patients also had a prolonged hospital stay (27.9 vs. 24.3 days) and a significantly longer ICU stay (8.6 vs. 3.7 days; p = 0.033), and required twice as many transfusions. Overall, 3 patients died following surgery, 1 with Child A (3% of all Child A patients) and 2 with Child B cirrhosis.
Pancreatic surgery is associated with an increased risk of postoperative complications in patients with liver cirrhosis, and is therefore not recommended in patients with Child B cirrhosis. In Child A cirrhotic patients the mortality is, however, comparable to noncirrhotic patients. Due to the demanding medical efforts that these patients require, they should be treated exclusively in high-volume centers. and IAP.
背景/目的：胰腺手术与术后并发症的风险增加有关。因此，我们通过对我院行胰腺手术的伴有或不伴有肝硬化的患者的病例对照研究，来探讨肝功能障碍对术后结果的影响。
1998 年至 2008 年期间，共进行了 1649 例胰腺切除术。其中，32 例手术在患有肝硬化的患者中进行（30 例 Child A，2 例 Child B）。在我们的病例对照研究中，我们还选择了另外 32 例无肝硬化的手术患者，他们按照年龄、性别、诊断和肿瘤分类进行匹配。比较两组患者之间的以下参数：手术时间、输血次数、ICU 和住院时间、并发症发生率、再次手术率、死亡率。
肝硬化患者发生并发症的比例显著更高（69%比 44%；p = 0.044），尤其是需要再次手术的严重并发症（47%比 22%；p = 0.035）。这些患者的住院时间也更长（27.9 天比 24.3 天），ICU 时间也显著延长（8.6 天比 3.7 天；p = 0.033），并且需要输血的次数也更多。总的来说，有 3 例患者术后死亡，1 例为 Child A（所有 Child A 患者的 3%），2 例为 Child B 肝硬化。
胰腺手术与肝硬化患者术后并发症的风险增加相关，因此不建议在 Child B 肝硬化患者中进行。然而，在 Child A 肝硬化患者中，死亡率与非肝硬化患者相当。由于这些患者需要付出艰巨的医疗努力，他们应该仅在高容量中心接受治疗。
