Koizumi Chie, Michihata Nobuaki, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.
World J Surg. 2018 Mar;42(3):816-822. doi: 10.1007/s00268-017-4189-y.
Hepatic portal venous gas (HPVG) is rare but potentially serious condition. Main cause of HPVG is bowel ischemia, while detection of HPVG without bowel ischemia may have been increasing possibly due to widespread use of computed tomography. However, little is known about variation in etiologies of HPVG and mortality of HPVG with each etiology. We examined patient backgrounds, underlying diseases, and in-hospital mortality of HPVG patients using a national inpatient database.
Using the Diagnosis Procedure Combination database in Japan, we identified inpatients diagnosed with HPVG from July 1, 2010 to March 31, 2015. Patients' data included age, sex, comorbidities at admission, complications after admission, body mass index, surgical procedures, medications, and discharge status. In-hospital mortality was compared between the subgroups divided by the patient backgrounds and underlying diseases.
A total of 1590 patients were identified during the study period. The mean age was 79.3 years old and the proportion of bowel ischemia was 53%. The overall in-hospital mortality was 27.3%. In-hospital mortality of HPVG with bowel ischemia, gastrointestinal tract (GIT) obstruction or dilation, GIT perforation, GIT infection, or sepsis was 26.8, 31.1, 33.3, 13.6, or 56.4%, respectively. Among patients with bowel ischemia, 32.2% patients received operation and their in-hospital mortality was 16.5%.
HPVG patients in the present study were relatively older but less likely to die than those in previous studies. Attention should be paid to the fact that mortality of HPVG without bowel ischemia was not always lower compared to that with bowel ischemia.
肝门静脉积气（HPVG）虽罕见但可能是严重病症。HPVG的主要病因是肠缺血，而无肠缺血情况下HPVG的检出率可能因计算机断层扫描的广泛应用而有所增加。然而，关于HPVG病因的差异以及每种病因导致的HPVG死亡率知之甚少。我们使用全国住院患者数据库研究了HPVG患者的患者背景、基础疾病和住院死亡率。
利用日本诊断程序组合数据库，我们确定了2010年7月1日至2015年3月31日期间诊断为HPVG的住院患者。患者数据包括年龄、性别、入院时的合并症、入院后的并发症、体重指数、手术操作、用药情况和出院状态。比较按患者背景和基础疾病划分的亚组之间的住院死亡率。
研究期间共确定了1590例患者。平均年龄为79.3岁，肠缺血的比例为53%。总体住院死亡率为27.3%。伴有肠缺血、胃肠道（GIT）梗阻或扩张、GIT穿孔、GIT感染或脓毒症的HPVG患者的住院死亡率分别为26.8%、31.1%、33.3%、13.6%或56.4%。在肠缺血患者中，32.2%的患者接受了手术，其住院死亡率为16.5%。
本研究中的HPVG患者年龄相对较大，但与先前研究中的患者相比死亡可能性较小。应注意的是，无肠缺血的HPVG死亡率并不总是低于有肠缺血的情况。
