Wei Li, Hong Wu, Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2017 May 28;23(20):3702-3712. doi: 10.3748/wjg.v23.i20.3702.
to investigate the short-term outcomes and risk factors indicating postoperative death of patients with lesions adjacent to the hepatocaval confluence.
We retrospectively analyzed 54 consecutive patients who underwent hepatectomy combined with inferior vena cava (IVC) and/or hepatic vein reconstruction (HVR) from January 2012 to January 2016 at our liver surgery center. The patients were divided into 5 groups according to the range of IVC and hepatic vein involvement. The patient details, indications for surgery, operative techniques, intra- and postoperative outcomes were compared among the 5 groups. Univariate and multivariate analyses were performed to explore factors predictive of overall operative death.
IVC replacement was carried out in 37 (68.5%) patients and HVR in 17 (31.5%) patients. Type I2H2 had the longest operative blood loss, operative duration and overall liver ischemic time (all, < 0.05). Three patients of Type I3H1 with totally occluded IVC did not need IVC reconstruction. Total postoperative morbidity rate was 40.7% (22 patients) and the operative mortality rate was 16.7% (9 patients). Factors predictive of operative death included IVC replacement ( = 0.048), duration of liver ischemia ( = 0.005) and preoperative liver function being Child-Pugh B ( = 0.025).
IVC replacement, duration of liver ischemia and preoperative poor liver function were risk factors predictive of postoperative death. We should be cautious about IVC replacement, especially in Type I2H2. For Type I3H1, it was unnecessary to replace IVC when the collateral circulation was established.
探讨临近肝静脉汇合部病变患者术后死亡的短期预后及相关危险因素。
回顾性分析 2012 年 1 月至 2016 年 1 月我院肝脏外科中心连续收治的 54 例行肝切除术联合下腔静脉（IVC）和/或肝静脉重建（HVR）的患者。根据 IVC 和肝静脉受累范围，将患者分为 5 组。比较 5 组患者的一般资料、手术适应证、手术技术、围手术期结果。采用单因素和多因素分析探讨影响总体手术死亡率的因素。
37 例（68.5%）患者行 IVC 置换，17 例（31.5%）患者行 HVR。II2H2 型患者术中出血量、手术时间和全肝缺血时间最长（均<0.05）。3 例完全闭塞型 I3H1 患者无需行 IVC 重建。术后总并发症发生率为 40.7%（22 例），手术死亡率为 16.7%（9 例）。预测手术死亡的因素包括 IVC 置换（ = 0.048）、肝缺血时间（ = 0.005）和术前肝功能为 Child-Pugh B 级（ = 0.025）。
IVC 置换、肝缺血时间和术前肝功能不良是预测术后死亡的危险因素。我们应该谨慎进行 IVC 置换，特别是在 II2H2 型。对于 I3H1 型，当侧支循环建立时，无需置换 IVC。
