Service de Transplantation, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
Service d'Hépato-Gastroentérologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
Hepatology. 2019 Sep;70(3):911-924. doi: 10.1002/hep.30628. Epub 2019 May 21.
In patients with idiopathic noncirrhotic portal hypertension (INCPH), data on morbidity and mortality of abdominal surgery are scarce. We retrospectively analyzed the charts of patients with INCPH undergoing abdominal surgery within the Vascular Liver Disease Interest Group network. Forty-four patients with biopsy-proven INCPH were included. Twenty-five (57%) patients had one or more extrahepatic conditions related to INCPH, and 16 (36%) had a history of ascites. Forty-five procedures were performed, including 30 that were minor and 15 major. Nine (20%) patients had one or more Dindo-Clavien grade ≥ 3 complication within 1 month after surgery. Sixteen (33%) patients had one or more portal hypertension-related complication within 3 months after surgery. Extrahepatic conditions related to INCPH (P = 0.03) and history of ascites (P = 0.02) were associated with portal hypertension-related complications within 3 months after surgery. Splenectomy was associated with development of portal vein thrombosis after surgery (P = 0.01). Four (9%) patients died within 6 months after surgery. Six-month cumulative risk of death was higher in patients with serum creatinine ≥ 100 μmol/L at surgery (33% versus 0%, P < 0.001). An unfavorable outcome (i.e., either liver or surgical complication or death) occurred in 22 (50%) patients and was associated with the presence of extrahepatic conditions related to INCPH, history of ascites, and serum creatinine ≥ 100 μmol/L: 5% of the patients with none of these features had an unfavorable outcome versus 32% and 64% when one or two or more features were present, respectively. Portal decompression procedures prior to surgery (n = 10) were not associated with postoperative outcome. Conclusion: Patients with INCPH are at high risk of major surgical and portal hypertension-related complications when they harbor extrahepatic conditions related to INCPH, history of ascites, or increased serum creatinine.
在特发性非肝硬化性门静脉高压症（INCPH）患者中，有关腹部手术发病率和死亡率的数据很少。我们对血管肝病兴趣小组网络内接受腹部手术的 INCPH 患者的病历进行了回顾性分析。共纳入 44 例经活检证实为 INCPH 的患者。25 例（57%）患者存在 1 种或多种与 INCPH 相关的肝外疾病，16 例（36%）有腹水病史。共进行了 45 次手术，其中 30 次为小手术，15 次为大手术。术后 1 个月内有 9 例（20%）患者发生 1 种或多种 Dindo-Clavien 分级≥3 级并发症。术后 3 个月内有 16 例（33%）患者发生 1 种或多种与门静脉高压相关的并发症。与术后 3 个月内与门静脉高压相关的并发症相关的是与 INCPH 相关的肝外疾病（P=0.03）和腹水病史（P=0.02）。脾切除术与术后门静脉血栓形成的发展相关（P=0.01）。术后 6 个月内有 4 例（9%）患者死亡。手术时血清肌酐≥100μmol/L 的患者 6 个月内死亡的累积风险更高（33%比 0%，P<0.001）。6 个月时发生肝或手术并发症或死亡的不良结局（即不良结局）在 22 例（50%）患者中出现，与存在与 INCPH 相关的肝外疾病、腹水病史和血清肌酐≥100μmol/L 相关：无这些特征的患者中不良结局的发生率为 5%，而存在 1 种、2 种或更多种特征的患者的发生率分别为 32%和 64%。手术前门静脉减压术（n=10）与术后结局无关。结论：当 INCPH 患者存在与 INCPH 相关的肝外疾病、腹水病史或血清肌酐升高时，他们进行重大手术和与门静脉高压相关的并发症的风险很高。
