Grat Michal, Grzegorczyk Karolina, Lewandowski Zbigniew, Sujecki Damian, Szwedowski Dawid, Boltuc Adam, Smoter Piotr, Kornasiewicz Oskar, Krawczyk Marek
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland.
Department of Epidemiology, Medical University of Warsaw, Oczki Street, 02-007 Warsaw, Poland.
Hepatol Int. 2011 Jun 14;6(2):498-504. doi: 10.1007/s12072-011-9281-z. eCollection 2012 Apr.
Risk of liver resection has been well investigated in many studies. However, the problem of intraoperative injuries is rarely mentioned. The aim of this study was to assess the incidence, the type, and management of intraoperative injuries during liver resection.
A total of 1,005 liver resections between 2004 and 2009 were included in this retrospective investigation. We analyzed the incidence of intraoperative injuries, risk factors, and an impact on patients' clinical outcome.
The overall incidence of intraoperative injuries was 4.4% (44 of 1,005). Injuries of the diaphragm (1.6%, 16 of 1,005) and hepatocaval junction (1%, 10 of 1,005) were the most frequent. In multivariate analysis, tumor recurrence ( = 0.0199) and tumor size ( = 0.0317) were the only independent risk factors for diaphragm injuries, whereas the extent of resection ( = 0.0007) was the only independent risk factor for caval or hepatic vein injuries. Injuries of the inferior vena cava or hepatic veins significantly increased perioperative mortality ( = 0.0005).
Minor injuries causing no significant complications were the most frequent. However, prevention and proper management of the rare injuries of hepatocaval junction are essential to avoid increased mortality in major liver resections.
许多研究对肝切除的风险进行了充分调查。然而，术中损伤的问题很少被提及。本研究的目的是评估肝切除术中术中损伤的发生率、类型及处理方法。
本回顾性研究纳入了2004年至2009年间共1005例肝切除术。我们分析了术中损伤的发生率、危险因素及其对患者临床结局的影响。
术中损伤的总体发生率为4.4%（1005例中的44例）。膈肌损伤（1.6%，1005例中的16例）和肝腔静脉交界处损伤（1%，1005例中的10例）最为常见。多因素分析显示，肿瘤复发（P = 0.0199）和肿瘤大小（P = 0.0317）是膈肌损伤的唯一独立危险因素，而切除范围（P = 0.0007）是腔静脉或肝静脉损伤 的唯一独立危险因素。下腔静脉或肝静脉损伤显著增加围手术期死亡率（P = 0.0005）。
无明显并发症的轻微损伤最为常见。然而，预防和妥善处理罕见的肝腔静脉交界处损伤对于避免大肝切除术中死亡率增加至关重要。
