Carrapita Jorge Gomes, Rocha Clara, Donato Henrique, Costa Alexandre, Abrantes Ana Margarida, Santos Jorge Nunes, Botelho Maria Filomena, Tralhão José Guilherme, Barbosa Jorge Maciel
Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto; Serviço de Cirurgia Geral. Centro Hospitalar de Vila Nova de Gaia / Espinho. Vila Nova de Gaia. Portugal.
ESTESC-Coimbra Health School Department Complementary Sciences. Polytechnic Institute of Coimbra. Coimbra. Institute for Systems Engineering and Computers at Coimbra (INESCC). Coimbra. Portugal.
Acta Med Port. 2019 Jun 28;32(6):420-426. doi: 10.20344/amp.10892.
Excessive portal venous pressure in the liver remnant is an independent factor in the occurrence of posthepatectomy liver failure and small-for-size syndrome. The baseline portal pressure prior to hepatectomy was not considered previously. The aim of this study is to assess the impact of portal pressure change during hepatectomy on the patient outcome.
Prospective observational study including 30 patients subjected to intraoperative measurement of portal pressure before and after hepatectomy. This variation was related to the patient outcome. Control group evaluation was assessed. Patient, disease and procedure features were considered. The optimal cut-off of portal pressure variation was determined. Linear regression or logistic regression was applied to identify predictors of the outcome.
The univariate analysis showed that portal pressure increase after hepatectomy was associated with coagulation impairment in the first 30 postoperative days (p < 0.05), and with the occurrence of major complications (p = 0.01), namely hepatic failure (p = 0.041). The multivariate analysis showed that portal venous pressure increase ≥ 2 mmHg is an independent factor for worse outcomes.
As in previous studies, this study concludes that, after hepatectomy, in addition to the functional liver remnant, other factors are responsible for deterioration of liver function and patient outcome, such as the portal pressure increase and the exposure to chemotherapy prior to hepatectomy. This work may influence the definition of future indications for portal influx modulation.
Patient outcomes are influenced by the portal venous pressure increase: an increment ≥ 2 mmHg after hepatectomy seems to increase the risk of major complications.
肝切除术后肝残余组织中门静脉压力过高是肝切除术后肝衰竭和小肝综合征发生的独立因素。此前未考虑肝切除术前的基线门静脉压力。本研究旨在评估肝切除术中门静脉压力变化对患者预后的影响。
前瞻性观察性研究，纳入30例在肝切除术前和术后接受术中门静脉压力测量的患者。这种变化与患者预后相关。对对照组进行评估。考虑患者、疾病和手术特征。确定门静脉压力变化的最佳临界值。应用线性回归或逻辑回归来确定预后的预测因素。
单因素分析显示，肝切除术后门静脉压力升高与术后前30天的凝血功能障碍相关（p < 0.05），并与主要并发症的发生相关（p = 0.01），即肝衰竭（p = 0.041）。多因素分析显示，门静脉压力升高≥2 mmHg是预后较差的独立因素。
与既往研究一样，本研究得出结论，肝切除术后，除了功能性肝残余组织外，其他因素也会导致肝功能恶化和患者预后不良，如门静脉压力升高和肝切除术前接受化疗。这项工作可能会影响未来门静脉血流调节适应症的定义。
患者预后受门静脉压力升高影响：肝切除术后升高≥2 mmHg似乎会增加主要并发症的风险。
