Department of Surgery, University of Heidelberg, Heidelberg, Germany.
Br J Surg. 2011 Dec;98(12):1760-5. doi: 10.1002/bjs.7675. Epub 2011 Oct 21.
Liver ischaemia after pancreatic resection is a rare but potentially serious complication. The aim of this study was to determine the impact of postoperative liver ischaemia after pancreatic resection.
All consecutive patients undergoing pancreatic resection between January 2007 and August 2008 in the Department of Surgery in Heidelberg were identified retrospectively from a prospectively collected database and analysed with a focus on postoperative hepatic perfusion failure. Laboratory data, computed tomography (CT) findings, symptoms, therapy and outcome were recorded.
A total of 762 patients underwent pancreatic resection in the study period. Seventeen patients (2·2 per cent) with a postoperative increase in liver enzymes underwent contrast-enhanced CT for suspected liver perfusion failure. The types of perfusion failure were hypoperfusion without occlusion of major hepatic vessels (6 patients) and ischaemia with arterial (5) and/or portal vein (6) involvement. The overall mortality rate was 29 per cent (5 of 17 patients). Therapy included conservative treatment (7), radiological or surgical revascularization and necrosectomy or resection of necrotic liver tissue (10). Outcome varied from full recovery (4 patients) to moderate systemic complications (6) and severe complications (7) including death. Simultaneous involvement of the portal vein and hepatic artery was always fatal.
Postoperative liver perfusion failure is a rare but potentially severe complication following pancreatic surgery requiring immediate recognition and, if necessary, radiological or surgical intervention.
胰腺切除术后肝缺血是一种罕见但潜在严重的并发症。本研究旨在确定胰腺切除术后肝缺血的影响。
回顾性地从一个前瞻性收集的数据库中确定了 2007 年 1 月至 2008 年 8 月期间在海德堡外科系接受胰腺切除术的所有连续患者，并重点分析了术后肝灌注衰竭。记录了实验室数据、计算机断层扫描（CT）发现、症状、治疗和结果。
在研究期间，762 名患者接受了胰腺切除术。17 名（2.2%）术后肝酶升高的患者因疑似肝灌注衰竭而行增强 CT 检查。灌注衰竭的类型为无主要肝血管闭塞的低灌注（6 例）和伴有动脉（5 例）和/或门静脉（6 例）受累的缺血。总的死亡率为 29%（17 例患者中的 5 例）。治疗包括保守治疗（7 例）、放射或手术再血管化以及坏死组织切除术或坏死肝组织切除术（10 例）。结果从完全恢复（4 例）到中度全身并发症（6 例）和严重并发症（7 例）包括死亡不等。门静脉和肝动脉的同时受累总是致命的。
胰腺手术后的肝灌注衰竭是一种罕见但潜在严重的并发症，需要立即识别，如果需要，还需要进行放射或手术干预。
