Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany.
HPB (Oxford). 2011 Aug;13(8):528-35. doi: 10.1111/j.1477-2574.2011.00319.x. Epub 2011 Jun 7.
A standardized definition of post-hepatectomy haemorrhage (PHH) has not yet been established.
An international study group of hepatobiliary surgeons from high-volume centres was convened and a definition of PHH was developed together with a grading of severity considering the impact on patients' clinical management.
The definition of PHH varies strongly within the hepatic surgery literature. PHH is defined as a drop in haemoglobin level > 3 g/dl post-operatively compared with the post-operative baseline level and/or any post-operative transfusion of packed red blood cells (PRBC) for a falling haemoglobin and/or the need for radiological intervention (such as embolization) and/or re-laparotomy to stop bleeding. Evidence of intra-abdominal bleeding should be obtained by imaging or blood loss via the abdominal drains if present. Transfusion of up to two units of PRBC is considered as being Grade A PHH. Grade B PHH requires transfusion of more than two units of PRBC, whereas the need for invasive re-intervention such as embolization and/ or re-laparotomy defines Grade C PHH.
The proposed definition and grading of severity of PHH enables valid comparisons of results from different studies. It is easily applicable in clinical routine and should be applied in future trials to standardize reporting of complications.
尚未建立肝切除术后出血 (PHH) 的标准化定义。
召集了来自高容量中心的肝胆外科国际研究小组，共同制定了 PHH 的定义，并根据对患者临床管理的影响进行了严重程度分级。
PHH 在肝脏手术文献中的定义差异很大。PHH 被定义为与术后基线水平相比，血红蛋白水平下降 >3 g/dl，和/或任何因血红蛋白下降而需要输注红细胞浓缩液（PRBC），和/或需要进行影像学介入（如栓塞）和/或剖腹手术以止血。如果存在腹腔引流管，应通过影像学检查或通过引流管获取腹腔内出血的证据。输注最多两单位的 PRBC 被认为是 A 级 PHH。输注超过两单位的 PRBC 需要 B 级 PHH，而需要侵入性再介入，如栓塞和/或剖腹手术来止血，则定义为 C 级 PHH。
提出的 PHH 定义和严重程度分级可实现对来自不同研究结果的有效比较。它在临床常规中易于应用，应在未来的试验中应用，以标准化并发症报告。
