Department of General Surgery, Medical University Vienna, Vienna, Austria.
Br J Surg. 2011 Dec;98(12):1752-8. doi: 10.1002/bjs.7672. Epub 2011 Oct 19.
Portal hypertension associated with liver cirrhosis increases the risk of postoperative complications after liver resection for hepatocellular carcinoma (HCC). This study assessed the role of preoperative hepatic venous pressure gradient (HVPG) assessment in identifying portal hypertension.
All patients who underwent liver resection for HCC between January 2000 and December 2009 at the Department of General Surgery, Medical University Vienna, were analysed retrospectively. HVPG was assessed prospectively in a subset of patients before liver resection. The influence of this assessment on postoperative complications was investigated.
A total of 132 patients were enrolled, of whom 39 underwent HVPG measurement. Mean(s.d.) HVPG was 6·4(3·0) and 4·3(1·4) mmHg in patients with and without postoperative complications respectively (P = 0·028). Complication rates differed significantly at a cut-off HVPG value of 5 mmHg: 11 of 21 patients with a gradient of 1-5 mmHg developed complications versus 12 of 14 patients with a higher value (P = 0·045). HVPG exceeding 5 mmHg was associated with worse liver fibrosis (P = 0·004), higher rates of postoperative liver dysfunction (5 of 13 versus 1 of 18; P = 0·022) and ascites (7 of 14 versus 3 of 21; P = 0·022), and a longer hospital stay (median (range) 11 (7-26) versus 8 (4-20) days; P = 0·034). Overall postoperative morbidity did not differ between patients who had preoperative HVPG assessment and those who did not (P = 0·142).
Preoperative HVPG assessment predicted liver fibrosis and postoperative complications.
与肝硬化相关的门静脉高压症增加了肝细胞癌（HCC）患者肝切除术后发生并发症的风险。本研究评估了术前肝静脉压力梯度（HVPG）评估在识别门静脉高压症中的作用。
回顾性分析了 2000 年 1 月至 2009 年 12 月维也纳医科大学普通外科接受 HCC 肝切除术的所有患者。在肝切除术前对部分患者进行了前瞻性 HVPG 评估。研究调查了这种评估对术后并发症的影响。
共纳入 132 例患者，其中 39 例行 HVPG 测量。术后并发症患者的 HVPG 平均值（标准差）为 6.4（3.0）mmHg，无并发症患者为 4.3（1.4）mmHg（P = 0.028）。HVPG 临界值为 5mmHg 时，并发症发生率差异显著：梯度为 1-5mmHg 的 21 例患者中有 11 例发生并发症，梯度>5mmHg 的 14 例患者中有 12 例发生并发症（P = 0.045）。HVPG 超过 5mmHg 与更严重的肝纤维化相关（P = 0.004）、术后肝功能障碍发生率更高（5/13 例与 1/18 例；P = 0.022）、腹水发生率更高（7/14 例与 3/21 例；P = 0.022）、住院时间更长（中位数（范围）为 11（7-26）天与 8（4-20）天；P = 0.034）。有术前 HVPG 评估的患者与无术前 HVPG 评估的患者术后总体发病率无差异（P = 0.142）。
术前 HVPG 评估可预测肝纤维化和术后并发症。
