Monden Kazuteru, Sadamori Hiroshi, Hioki Masayoshi, Ohno Satoshi, Saneto Hiromi, Ueki Toru, Yabushita Kazuhisa, Ono Kazumi, Sakaguchi Kousaku, Takakura Norihisa
Department of Gastroenterological Surgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan.
Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan.
J Hepatobiliary Pancreat Sci. 2017 Jul;24(7):375-381. doi: 10.1002/jhbp.461. Epub 2017 Jun 5.
Aspirin is widely used for the secondary prevention of ischemic stroke and cardiovascular disease. Perioperative aspirin may decrease thrombotic morbidity, but may also increase hemorrhagic morbidity. In particular, liver resection carries risks of bleeding, leading to higher risks of hemorrhagic morbidity. Our institution has continued aspirin therapy perioperatively in patients undergoing liver resection. This study examined the safety and feasibility of liver resection while continuing aspirin.
We retrospectively evaluated 378 patients who underwent liver resection between January 2010 and January 2016. Patients were grouped according to preoperative aspirin prescription: patients with aspirin therapy (aspirin users, n = 31); and patients without use of aspirin (aspirin non-users, n = 347).
Aspirin users were significantly older (P < 0.001), with a higher proportion of males (P < 0.001) and higher frequencies of hypertension (P = 0.004) and diabetes mellitus (P < 0.001). No significant differences were observed in intraoperative parameters. Although the frequency of major morbidity tended to be higher among aspirin users than among aspirin non-users, no significant difference was identified. No postoperative hemorrhage was seen among aspirin users.
Liver resection can be safely performed while continuing aspirin therapy without increasing hemorrhagic morbidity. Our results suggest that interruption of aspirin therapy is unnecessary for patients undergoing liver resection.
阿司匹林广泛用于缺血性中风和心血管疾病的二级预防。围手术期使用阿司匹林可能会降低血栓形成的发病率，但也可能增加出血性发病率。特别是肝切除术存在出血风险，导致出血性发病率更高。我们机构在接受肝切除术的患者围手术期持续使用阿司匹林治疗。本研究探讨了在持续使用阿司匹林的情况下进行肝切除术的安全性和可行性。
我们回顾性评估了2010年1月至2016年1月期间接受肝切除术的378例患者。根据术前阿司匹林处方对患者进行分组：接受阿司匹林治疗的患者（阿司匹林使用者，n = 31）；未使用阿司匹林的患者（非阿司匹林使用者，n = 347）。
阿司匹林使用者年龄显著更大（P < 0.001），男性比例更高（P < 0.001），高血压（P = 0.004）和糖尿病（P < 0.001）的发生率更高。术中参数未观察到显著差异。虽然阿司匹林使用者中主要并发症的发生率往往高于非阿司匹林使用者，但未发现显著差异。阿司匹林使用者中未出现术后出血情况。
在持续阿司匹林治疗的情况下可以安全地进行肝切除术，而不会增加出血性发病率。我们的结果表明，接受肝切除术的患者无需中断阿司匹林治疗。
