Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Germany.
Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Ann Surg. 2021 Jul 1;274(1):e10-e17. doi: 10.1097/SLA.0000000000003496.
The aim of this study was to assess intraoperative changes of hepatic macrohemodynamics and their association with ascites and posthepatectomy liver failure (PHLF) after major hepatectomy.
Large-scale ascites and PHLF remain clinical challenges after major hepatectomy. No study has concomitantly evaluated arterial and venous liver macrohemodynamics in patients undergoing liver resection.
Portal venous pressure (PVP), portal venous flow (PVF), and hepatic arterial flow (HAF) were measured intraoperatively pre- and postresection in 67 consecutive patients with major hepatectomy (ie, resection of ≥3 liver segments). A group of 30 patients with minor hepatectomy served as controls. Liver macrohemodynamics and their intraoperative changes (ie, Δ) were analyzed as predictive biomarkers of ascites and PHLF using Fisher exact, t test, or Wilcoxon rank sum test for univariate and logistic regression for multivariate analyses.
Major hepatectomy increased PVP by 26.9% (P = 0.001), markedly decreased HAF by 40.7% (P < 0.001), and slightly decreased PVF by 13.4% (P = 0.011). Minor resections had little effects on hepatic macrohemodynamics. There was no significant association of liver macrohemodynamics with ascites. While middle hepatic vein resection caused higher postresection PVP after right hepatectomy (P = 0.04), the Pringle maneuver was associated with a significant PVF (P = 0.03) and HAF reduction (P = 0.03). Uni- and multivariate analysis revealed an intraoperative PVP increase as an independent predictor of PHLF (P = 0.025).
Intraoperative PVP kinetics serve as independent predictive biomarker of PHLF after major hepatectomy. These data highlight the importance to assess intraoperative dynamics rather than the pre- and postresection PVP values.
本研究旨在评估肝大宏观血流动力学的术中变化及其与大肝切除术后腹水和肝切除术后肝功能衰竭（PHLF）的关系。
大肝切除术后，大量腹水和 PHLF 仍然是临床挑战。尚无研究同时评估行肝切除术患者的动脉和静脉肝大宏观血流动力学。
在 67 例连续行大肝切除术（即切除≥3 个肝段）的患者中，分别于术前和术后测量门静脉压（PVP）、门静脉血流量（PVF）和肝动脉血流量（HAF）。30 例小肝切除术患者作为对照组。使用 Fisher 确切检验、t 检验或 Wilcoxon 秩和检验进行单变量分析，使用逻辑回归进行多变量分析，将肝大宏观血流动力学及其术中变化（即Δ）作为腹水和 PHLF 的预测生物标志物进行分析。
大肝切除术使 PVP 增加了 26.9%（P = 0.001），明显降低了 HAF 达 40.7%（P < 0.001），并使 PVF 略有降低 13.4%（P = 0.011）。小切除术对肝大宏观血流动力学影响较小。肝大宏观血流动力学与腹水无显著相关性。右半肝切除时中肝静脉切除后肝右静脉阻断后 PVP 升高（P = 0.04），而阻断入肝血流与 PVF（P = 0.03）和 HAF 降低（P = 0.03）显著相关。单变量和多变量分析显示，术中 PVP 升高是 PHLF 的独立预测指标（P = 0.025）。
术中 PVP 动力学是大肝切除术后 PHLF 的独立预测生物标志物。这些数据强调了评估术中动态变化而不仅仅是术前和术后 PVP 值的重要性。
