肝切除术后肝衰竭的发生率由活体供肝肝移植国际研究小组界定。
The Incidence of Posthepatectomy Liver Failure Defined by the International Study Group of Liver Surgery among Living Donors.
作者信息
Kuramitsu Kaori, Fukumoto Takumi, Kobayashi Tsuyoshi, Fukushima Kenji, Okimoto Sho, Iwasaki Takeshi, Tominaga Masahiro, Zen Yoh, Ohdan Hideki, Ku Yonson
机构信息
Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, Japan.
Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
出版信息
J Gastrointest Surg. 2016 Apr;20(4):757-64. doi: 10.1007/s11605-016-3080-8. Epub 2016 Jan 20.
BACKGROUND
Although several publications have reported donor morbidities, deterioration of liver function, which may cause posthepatectomy liver failure (PHLF), was not assessed specifically.
METHODS
The incidence of PHLF proposed by the International Study Group of Liver Surgery (ISGLS-PHLF) was analyzed among 257 living donors. ISGLS-PHLF was defined by an increased international normalized ratio and hyperbilirubinemia on or after postoperative day 5.
RESULTS
ISGLS-PHLF was identified in 21 donors (8%), of which 18 (85.7%) were grade A, 2 (9.5%) were grade B, and 1 (4.8%) was grade C. The average hospital stay without ISGLS-PHLF was 15 ± 1 days, which extended along with increasing grades (p = 0.03). In univariate analysis, right hepatectomy was significantly associated with the incidence of ISGLS-PHLF (p = 0.02), and right hepatectomy (p = 0.002) and operation time (p = 0.01) in multivariate analysis. Of 176 right lobe donors, 19 (10.8%) developed ISGLS-PHLF, of which 16 (84.2%) were grade A, 2 (10.5%) were grade B, and 1 (5.3%) was grade C. Operation time was significantly associated with the incidence of ISGLS-PHLF in univariate (p = 0.002) and multivariate (p = 0.003) analyses.
CONCLUSIONS
Right lobe donation surgery is associated with a higher incidence of ISGLS-PHLF.
背景
尽管有几篇文献报道了供体的并发症，但未对可能导致肝切除术后肝功能衰竭（PHLF）的肝功能恶化进行专门评估。
方法
分析了国际肝外科学研究组提出的PHLF（ISGLS-PHLF）在257例活体供体中的发生率。ISGLS-PHLF定义为术后第5天及以后国际标准化比值升高和高胆红素血症。
结果
21例（8%）供体被诊断为ISGLS-PHLF，其中18例（85.7%）为A级，2例（9.5%）为B级，1例（4.8%）为C级。无ISGLS-PHLF的患者平均住院时间为15±1天，且随着分级增加而延长（p = 0.03）。单因素分析中，右半肝切除术与ISGLS-PHLF的发生率显著相关（p = 0.02），多因素分析中右半肝切除术（p = 0.002）和手术时间（p = 0.01）也与之相关。在176例右叶供体中，19例（10.8%）发生ISGLS-PHLF，其中16例（84.2%）为A级，2例（10.5%）为B级，1例（5.3%）为C级。单因素（p = 0.002）和多因素（p = 0.003）分析中，手术时间均与ISGLS-PHLF的发生率显著相关。
结论
右叶供肝手术与ISGLS-PHLF的较高发生率相关。
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