Swiss HPB Center, Department of Surgery, University of Zurich Hospital, Switzerland.
HPB (Oxford). 2013 Jun;15(6):411-7. doi: 10.1111/hpb.12001. Epub 2012 Nov 28.
Two-stage liver resections with portal vein occlusion have become standard in patients with low volume future liver remnants. Whether they are associated with more complications is unclear. The aim of this study was to compare complications of one- and two-stage resections in a retrospective study.
Patients with two-stage right liver resections with a previous portal vein occlusion were compared with patients with one-stage right liver resections between 2002 and 2010. Primary endpoints were the incidence of complications by severity. Secondary endpoints were mortality, post-operative liver- and kidney function tests, length of hospitalization and transfusion events. Logistic and linear regression analyses were performed to adjust for confounders.
The groups were comparable except for right trisectionectomies, pre-operative chemotherapy and underlying liver disease. Overall complications occurred in 25 out of 35 patients with two-stage and 106 out of 163 in one-stage procedures. Severe complications were observed in 47 out of 163 patients versus 9 out of 35 patients, respectively. Two-stage procedures had no increased adjusted risk for complications [relative risk (RR) 0.9, P = 0.79]. Mortality (5.7% versus 3.7%) and post-operative liver failure rates (2.9% versus 3.1%) were low. Secondary endpoints showed no adjusted differences in risk.
This study suggests that liver resections in two stages are not associated with more post-operative complications than one-stage resections. These results should support the adoption of two-stage liver resections in selected patients.
对于未来肝剩余体积较小的患者，两阶段肝切除术联合门静脉阻断已成为标准治疗方法。但目前尚不清楚这种方法是否会增加并发症的发生率。本研究旨在通过回顾性研究比较两阶段和单阶段肝切除术的并发症。
本研究比较了 2002 年至 2010 年间行两阶段右半肝切除术（先前行门静脉阻断）和单阶段右半肝切除术的患者。主要终点为严重程度不同的并发症发生率。次要终点为死亡率、术后肝肾功能检查、住院时间和输血事件。采用逻辑回归和线性回归分析调整混杂因素。
两组患者除右三叶切除术、术前化疗和基础肝病外，其他方面均具有可比性。两阶段组有 35 例患者发生 25 例并发症，单阶段组有 163 例患者发生 106 例并发症。两阶段组和单阶段组严重并发症的发生率分别为 47/163（29%）和 9/35（26%）。多因素调整后，两阶段手术并不增加并发症的风险[相对危险度（RR）0.9，P = 0.79]。两组死亡率（5.7%比 3.7%）和术后肝功能衰竭发生率（2.9%比 3.1%）均较低。次要终点的风险无调整差异。
本研究表明，与单阶段肝切除术相比，两阶段肝切除术并不会增加术后并发症的发生率。这些结果应该支持在选择合适的患者时采用两阶段肝切除术。
