在加速康复外科时代，肝脏切除治疗恶性和良性疾病后的短期结局
Short-term outcomes after liver resection for malignant and benign disease in the age of ERAS.
作者信息
Hughes Michael J, Chong Jingli, Harrison Ewen, Wigmore Stephen
机构信息
Department of Clinical Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
Department of Clinical Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK.
出版信息
HPB (Oxford). 2016 Feb;18(2):177-182. doi: 10.1016/j.hpb.2015.10.011. Epub 2015 Nov 19.
INTRODUCTION
Enhanced Recovery After Surgery protocols have been implemented effectively after liver resection and provide benefits in terms of general morbidity rates. In order to optimise peri-operative care protocols and minimise morbidity, further investigation is required to identify factors associated with poor outcome after liver resection.
METHODS
A retrospective analysis of patients undergoing liver resection and enhanced recovery care between January 2006 and September 2012 was conducted. Data were collected on patient outcome and demographics, operative and pathological details. Univariate and multivariate analyses were performed to determine independent predictors of adverse outcome.
RESULTS
603 patients underwent liver resection during the study period. Morbidity and mortality rates were 34.3% and 1.5% respectively. The only predictor of major morbidity was extended resection (OR 4.079; 95% CI 2.177-7.642).
CONCLUSIONS
Extended resection is associated with major morbidity. When determining optimum peri-operative care, ERAS protocols must incorporate care components that can mitigate against morbidity associated with extended resection.
引言
手术后加速康复方案已在肝切除术后有效实施，并在总体发病率方面带来益处。为了优化围手术期护理方案并降低发病率，需要进一步研究以确定肝切除术后预后不良的相关因素。
方法
对2006年1月至2012年9月期间接受肝切除及加速康复护理的患者进行回顾性分析。收集了患者的预后和人口统计学数据、手术及病理细节。进行单因素和多因素分析以确定不良预后的独立预测因素。
结果
在研究期间，603例患者接受了肝切除术。发病率和死亡率分别为34.3%和1.5%。扩大切除术是主要并发症的唯一预测因素（比值比4.079；95%置信区间2.177 - 7.642）。
结论
扩大切除术与主要并发症相关。在确定最佳围手术期护理时，加速康复方案必须纳入能够减轻与扩大切除术相关并发症的护理措施。
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