Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France; AixMarseille University, Marseille, France.
Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France.
HPB (Oxford). 2018 Sep;20(9):865-871. doi: 10.1016/j.hpb.2018.03.011.
Acute kidney injury (AKI) following major hepatectomy (MH) remains inadequately investigated. This retrospective study aimed to assess the risk factors and prognostic value of AKI on short-term outcomes following MH without portal pedicle clamping.
From January 2014 through June 2017, 111 consecutive patients underwent MH without portal pedicle clamping, but with intraoperative low-crystalloid infusion. Kidney Disease Improving Global Outcomes stages II and III were classified as severe AKI.
A total of 102 patients did not develop AKI or only AKI stage I (92%, control group), whereas 9 patients developed severe AKI (8%, severe AKI group). Hepatectomy (P = 0.002) and surgery (P = 0.011) durations were longer in the severe AKI group. Clavien-Dindo grades 3 to 5 morbidity (55% versus 9%, P = 0.001), liver failure (P = 0.017), and 90-day mortality (33% versus 2%, P = 0.003) were significantly higher in the severe AKI group. After a multivariate analysis, the duration of hepatectomy (cut-off: 250 min; P = 0.029) and urea serum levels on postoperative day 3 (P = 0.006) were identified as independent predictors of severe AKI.
Severe AKI, is common with increased duration of hepatectomy, was associated with poor short-term outcomes, and can be predicted by operative duration greater than 250 minutes.
肝切除术（MH）后急性肾损伤（AKI）仍未得到充分研究。本回顾性研究旨在评估无门脉蒂阻断的 MH 后 AKI 对短期结局的风险因素和预后价值。
2014 年 1 月至 2017 年 6 月，111 例连续患者接受了无门脉蒂阻断但术中输注低晶液体的 MH。肾脏病改善全球结局（KDIGO）分期 II 和 III 期被归类为严重 AKI。
共有 102 例患者未发生 AKI 或仅发生 AKI Ⅰ期（92%，对照组），而 9 例患者发生严重 AKI（8%，严重 AKI 组）。严重 AKI 组的肝切除术（P=0.002）和手术（P=0.011）时间更长。严重 AKI 组的 Clavien-Dindo 3 至 5 级发病率（55%对 9%，P=0.001）、肝功能衰竭（P=0.017）和 90 天死亡率（33%对 2%，P=0.003）明显更高。多变量分析后，肝切除术时间（截止值：250 分钟；P=0.029）和术后第 3 天血尿素水平（P=0.006）被确定为严重 AKI 的独立预测因素。
严重 AKI 与肝切除术时间延长有关，与短期结局不良相关，手术时间大于 250 分钟可预测严重 AKI。
