*AP-HP, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France †Université Paris-Sud, Villejuif, France ‡Inserm, Unité 785, Villejuif, France §Inserm, Unité 776, Villejuif, France.
Ann Surg. 2013 Nov;258(5):822-9; discussion 829-30. doi: 10.1097/SLA.0b013e3182a64b38.
To evaluate the predictive value of portal vein pressure (PVP) after major liver resection for posthepatectomy liver failure (PLF) and 90-day mortality in patients without cirrhosis.
As elevated PVP is associated with liver failure after living donor liver transplantation, we hypothesized that the outcome after major hepatectomy may be influenced by posthepatectomy PVP.
All patients without severe fibrosis or cirrhosis who underwent a major liver resection (≥3 segments) with an intraoperative measurement of PVP at the end of the procedure were included. Outcome was analyzed regarding 3 most widely used definitions of PLF: "50-50" criteria, peak of serum bilirubin greater than 120 μmol/L, and grade C PLF proposed by the International Study Group of Liver Surgery (ISGLS). Receiver operating characteristic curves and logistic regression model were used to determine the optimal cutoff of PVP and independent risk factors of PLF.
The study population consisted of 277 patients. Posthepatectomy PVP was gradually correlated with the PLF risk. Probability for PLF was nil when PVP was 10 mm Hg or less, ranges from 13% to 16%, depending on PLF definitions, when PVP was 20 mm Hg, and from 24% to 33% when PVP was 30 mm Hg. The optimal value of posthepatectomy PVP to predict PLF was 22 mm Hg when considering the "50-50" criteria and grade C PLF (proposed by the International Study Group of Liver Surgery). A value of 21 mm Hg best predicted PLF defined by peak of serum bilirubin greater than 120 μmol/L and 90-day mortality. At multivariate analysis, posthepatectomy PVP remained an independent predictor of PLF as well as the extent of resection, intraoperative transfusion, and the presence of diabetes. The 90-day mortality was associated with PVP greater than 21 mm Hg, older than 70 years, and intraoperative transfusion.
Posthepatectomy PVP is an independent predictive factor of PLF and of 90-day mortality after major liver resection in patients without cirrhosis. Intraoperative modulation of PVP would be advisable when PVP exceeds 20 mm Hg.
评估无肝硬化患者行大肝切除术后门静脉压力（PVP）与肝切除术后肝功能衰竭（PLF）及 90 天死亡率的相关性。
由于升高的 PVP 与活体供肝移植后肝衰竭有关，我们假设肝切除术后的结局可能受到术后 PVP 的影响。
所有接受大肝切除（≥3 个节段）并在手术结束时测量术中 PVP 的无严重纤维化或肝硬化患者均纳入研究。根据 PLF 的三种最常用定义：“50-50”标准、血清胆红素峰值＞120μmol/L 和国际肝脏外科研究组（ISGLS）提出的 C 级 PLF 来分析结局。采用受试者工作特征曲线和逻辑回归模型确定 PVP 的最佳截断值和 PLF 的独立危险因素。
研究人群包括 277 例患者。术后 PVP 与 PLF 风险逐渐相关。当 PVP 为 10mmHg 或以下时，PLF 发生的概率为零，当 PVP 为 20mmHg 时，PLF 的概率为 13%-16%，当 PVP 为 30mmHg 时，PLF 的概率为 24%-33%。当考虑“50-50”标准和 C 级 PLF（ISGLS 提出）时，术后 PVP 预测 PLF 的最佳值为 22mmHg。当考虑血清胆红素峰值＞120μmol/L 和 90 天死亡率时，PVP 最佳预测值为 21mmHg。多变量分析显示，术后 PVP 仍是 PLF 以及肝切除范围、术中输血和糖尿病的独立预测因素。90 天死亡率与 PVP ＞21mmHg、年龄＞70 岁和术中输血有关。
无肝硬化患者行大肝切除术后，PVP 是 PLF 和 90 天死亡率的独立预测因素。当 PVP 超过 20mmHg 时，术中调节 PVP 可能是合理的。
