Pagano Duilio, Spada Marco, Parikh Vishal, Tuzzolino Fabio, Cintorino Davide, Maruzzelli Luigi, Vizzini Giovanni, Luca Angelo, Mularoni Alessandra, Grossi Paolo, Gridelli Bruno, Gruttadauria Salvatore
Duilio Pagano, Marco Spada, Fabio Tuzzolino, Davide Cintorino, Luigi Maruzzelli, Giovanni Vizzini, Angelo Luca, Alessandra Mularoni, Paolo Grossi, Bruno Gridelli, Salvatore Gruttadauria, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, 90127 Palermo, Italy.
World J Gastroenterol. 2014 Jun 14;20(22):6953-60. doi: 10.3748/wjg.v20.i22.6953.
To investigate whether early liver regeneration after resection in patients with hepatic tumors might be influenced by post-operative infective complications.
A retrospective analysis of 27 liver resections for tumors performed in a single referral center from November 2004 to January 2010. Regeneration was evaluated by multidetector computed tomography at a mean follow-up of 43.85 d. The Clavien-Dindo classification was used to evaluate postoperative events in the first 6 mo after transplantation, and Centers for Disease Control and Prevention definitions were used for healthcare associated infections data. Generalized linear regression models with Gaussian family distribution and log link function were used to reveal the principal promoters of early liver regeneration.
Ten of the 27 patients (37%) underwent chemotherapy prior to surgery, with a statistically significant prevalence of patients with metastasis (P = 0.007). Eight patients (30%) underwent embolization, 3 with primary tumors, and 5 with secondary tumors. Twenty patients (74%) experienced complications, with 12 (60%) experiencing Clavien-Dindo Grade 3a to 5 complications. Regeneration ≥ 100% occurred in 10 (37%) patients. The predictors were smaller future remnant liver volume (-0.002; P < 0.001), and a greater spleen volume/future remnant liver volume ratio (0.499; P = 0.01). Patients with a resection of ≥ 5 Couinaud segments experienced greater early regeneration (P = 0.04). Nine patients experienced surgical site infections, and in 7 cases Clavien-Dindo Grade 3a to 4 complications were detected (P = 0.016). There were no significant differences between patients with primary or secondary tumors, and either onset or infections or severity of surgical complications.
Regardless of the onset of infective complications, future remnant liver and spleen volumes may be reliable predictors of early liver regeneration after hepatic resection on an otherwise healthy liver.
探讨肝肿瘤患者肝切除术后早期肝再生是否会受到术后感染性并发症的影响。
对2004年11月至2010年1月在某单一转诊中心进行的27例肝脏肿瘤切除术进行回顾性分析。通过多排螺旋计算机断层扫描评估再生情况，平均随访时间为43.85天。采用Clavien-Dindo分类法评估移植后前6个月的术后事件，采用美国疾病控制与预防中心的定义收集医疗相关感染数据。使用具有高斯族分布和对数链接函数的广义线性回归模型来揭示早期肝再生的主要促进因素。
27例患者中有10例（37%）在手术前接受了化疗，转移患者的患病率具有统计学意义（P = 0.007）。8例患者（30%）接受了栓塞治疗，其中3例为原发性肿瘤，5例为继发性肿瘤。20例患者（74%）出现并发症，12例（60%）出现Clavien-Dindo 3a至5级并发症。10例（37%）患者的再生≥100%。预测因素为未来残余肝体积较小（-0.002；P < 0.001），以及脾体积/未来残余肝体积比值较大（0.499；P = 0.01）。切除≥5个Couinaud肝段的患者早期再生程度更高（P = 0.04）。9例患者发生手术部位感染，7例检测到Clavien-Dindo 3a至4级并发症（P = 0.016）。原发性或继发性肿瘤患者之间，以及手术并发症的发生、感染或严重程度方面均无显著差异。
无论感染性并发症的发生情况如何，对于肝脏健康的患者，未来残余肝体积和脾体积可能是肝切除术后早期肝再生的可靠预测指标。
