预测肝切除术后胆漏风险的临床评分
Clinical score to predict the risk of bile leakage after liver resection.
作者信息
Kajiwara Takahiro, Midorikawa Yutaka, Yamazaki Shintaro, Higaki Tokio, Nakayama Hisashi, Moriguchi Masamichi, Tsuji Shingo, Takayama Tadatoshi
机构信息
Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
Genome Science Division, Research Center for Advanced Science and Technologies, University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo, 153-8904, Japan.
出版信息
BMC Surg. 2016 May 6;16(1):30. doi: 10.1186/s12893-016-0147-0.
BACKGROUND
In liver resection, bile leakage remains the most common cause of operative morbidity. In order to predict the risk of this complication on the basis of various factors, we developed a clinical score system to predict the potential risk of bile leakage after liver resection.
METHODS
We analyzed the postoperative course in 518 patients who underwent liver resection for malignancy to identify independent predictors of bile leakage, which was defined as "a drain fluid bilirubin concentration at least three times the serum bilirubin concentration on or after postoperative day 3," as proposed by the International Study Group of Liver Surgery. To confirm the robustness of the risk score system for bile leakage, we analyzed the independent series of 289 patients undergoing liver resection for malignancy.
RESULTS
Among 81 (15.6 %) patients with bile leakage, 76 had grade A bile leakage, and five had grade C leakage and underwent reoperation. The median postoperative hospital stay was significantly longer in patients with bile leakage (median, 14 days; range, 8 to 34) than in those without bile leakage (11 days; 5 to 62; P = 0.001). There was no hepatic insufficiency or in-hospital death. The risk score model was based on the four independent predictors of postoperative bile leakage: non-anatomical resection (odds ratio, 3.16; 95 % confidence interval [CI], 1.72 to 6.07; P < 0.001), indocyanine green clearance rate (2.43; 1.32 to 7.76; P = 0.004), albumin level (2.29; 1.23 to 4.22; P = 0.01), and weight of resected specimen (1.97; 1.11 to 3.51; P = 0.02). When this risk score system was used to assign patients to low-, middle-, and high-risk groups, the frequency of bile leakage in the high-risk group was 2.64 (95 % CI, 1.12 to 6.41; P = 0.04) than that in the low-risk group. Among the independent series for validation, 4 (5.7 %), 16 (10.0 %), and 10 (16.6 %) patients in low-, middle, and high-risk groups were given a diagnosis of bile leakage after operation, respectively (P = 0.144).
CONCLUSIONS
Our risk score model can be used to predict the risk of bile leakage after liver resection.
背景
在肝切除术中，胆漏仍然是手术并发症最常见的原因。为了基于多种因素预测这种并发症的风险，我们开发了一种临床评分系统来预测肝切除术后胆漏的潜在风险。
方法
我们分析了518例行肝恶性肿瘤切除术患者的术后病程，以确定胆漏的独立预测因素，胆漏定义为国际肝外科学研究组提出的“术后第3天及以后引流液胆红素浓度至少为血清胆红素浓度的3倍”。为了证实胆漏风险评分系统的稳健性，我们分析了289例行肝恶性肿瘤切除术患者的独立队列。
结果
在81例（15.6%）发生胆漏的患者中，76例为A级胆漏，5例为C级胆漏并接受了再次手术。胆漏患者的术后中位住院时间（中位数14天；范围8至34天）显著长于无胆漏患者（11天；5至62天；P = 0.001）。未发生肝功能不全或院内死亡。风险评分模型基于术后胆漏的四个独立预测因素：非解剖性切除（比值比，3.16；95%置信区间[CI]，1.72至6.07；P < 0.001）、吲哚菁绿清除率（2.43；1.32至7.76；P = 0.004）、白蛋白水平（2.29；1.23至4.22；P = 0.01）和切除标本重量（1.97；1.11至3.51；P = 0.02）。当使用该风险评分系统将患者分为低、中、高风险组时，高风险组胆漏发生率比低风险组高2.64倍（95%CI，1.12至6.41；P = 0.04）。在用于验证的数据中，低、中、高风险组分别有4例（5.7%）、16例（10.0%）和10例（16.6%）患者术后被诊断为胆漏（P = 0.144）。
结论
我们的风险评分模型可用于预测肝切除术后胆漏的风险。
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