Zarski J P, Bichard P, Bourbon P, Tournery A, Demongeot J, Rachail M
Clinique d'Hépato-Gastroentérologie, CHRU de Grenoble.
Gastroenterol Clin Biol. 1988 Jan;12(1):43-7.
The purpose of this work was to study postoperative mortality and morbidity with respect to preoperative prognostic factors in 67 patients with alcoholic or posthepatitis cirrhosis. Surgical procedures involved the biliary tract (n = 20), stomach (n = 16), colon or rectum (n = 12), and hernia (n = 7). Thirteen preoperative clinical and biological variables were subjected to mono- and multivariate statistical analysis. The mortality rate was 23 p. 100. There was no statistical difference between the three main surgical procedures. No patients died after herniorrhaphy. The rate of morbidity was 37 p. 100. The most common complications were sepsis, organ failure, and ascites. Three preoperative variables were found to be different between survivors and non survivors: ascites, prothrombin time and the Child-Pugh score. Multidimensional analysis demonstrated that the only variable to have an independent unfavorable prognostic value was albuminemia. These results suggest that postoperative mortality following extrahepatic abdominal surgery in cirrhotic patients is: 1) especially high after digestive procedures, 2) increased by ascites, low prothrombin time and high Child-Pugh score. Only hypoalbuminemia had a significant independent explanatory value regarding prognosis.
本研究旨在探讨67例酒精性或肝炎后肝硬化患者术前预后因素与术后死亡率和发病率的关系。手术涉及胆道（n = 20）、胃（n = 16）、结肠或直肠（n = 12）以及疝（n = 7）。对13项术前临床和生物学变量进行单因素和多因素统计分析。死亡率为23%。三种主要手术方式之间无统计学差异。疝修补术后无患者死亡。发病率为37%。最常见的并发症是败血症、器官衰竭和腹水。发现幸存者和非幸存者之间有三个术前变量不同：腹水、凝血酶原时间和Child-Pugh评分。多因素分析表明，唯一具有独立不良预后价值的变量是低白蛋白血症。这些结果表明，肝硬化患者肝外腹部手术后的术后死亡率：1）在消化手术后尤其高，2）因腹水、凝血酶原时间缩短和Child-Pugh评分升高而增加。只有低白蛋白血症对预后具有显著的独立解释价值。
