Department of Surgery, Temple University Hospital, Philadelphia, PA.
Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ.
Surgery. 2021 May;169(5):1054-1060. doi: 10.1016/j.surg.2020.11.021. Epub 2020 Dec 24.
As the obesity epidemic worsens, the prevalence of fatty liver disease has increased. However, minimal data exist on the impact of combined fatty liver and metabolic syndrome on hepatectomy outcomes. Therefore, the aim of this analysis is to measure the outcomes of patients who do and do not have a fatty liver undergoing hepatectomy in the presence and absence of the metabolic syndrome.
Patients with fatty and normal livers undergoing major hepatectomy (≥3 segments) were identified in the 2014 to 2018 American College of Surgeon National Surgical Quality Improvement Program database. Patients undergoing partial hepatectomy and those with missing liver texture data were excluded. Propensity matching was used and adjusted for multiple variables. A subgroup analysis stratified by the metabolic syndrome (body mass index ≥30 kg/m, hypertension and diabetes) was performed. Demographics and outcomes were compared by χ and Mann-Whitney tests.
Of 2,927 hepatectomies, 30% of patients (N = 863) had a fatty liver. The median body mass index was 28.6, and the metabolic syndrome was present in 6.3% of patients (N = 184). After propensity matching, 863 patients with fatty and 863 with normal livers were compared. Multiple outcomes were significantly worse in patients with fatty livers (P <.05), including serious morbidity (32% vs 24%), postoperative invasive biliary procedures (15% vs 10%), organ space infections (11% vs 7.8%), and pulmonary complications. Patients with fatty livers and the metabolic syndrome had significantly increased postoperative cardiac arrests, pulmonary embolisms, and mortality (P < .05).
Fatty liver disease is associated with significantly worse outcomes after major hepatectomy. The metabolic syndrome confers an increased risk of postoperative mortality.
随着肥胖症的流行加剧，脂肪肝疾病的患病率也有所增加。然而，关于脂肪肝合并代谢综合征对肝切除术结果的影响的数据很少。因此，本分析旨在衡量在存在和不存在代谢综合征的情况下，患有脂肪肝和正常肝脏的患者行肝切除术的结果。
在美国外科医师学院国家手术质量改进计划数据库中，确定了 2014 年至 2018 年期间接受主要肝切除术（≥3 个节段）的脂肪肝和正常肝脏患者。排除了接受部分肝切除术和肝纹理数据缺失的患者。采用倾向匹配，并对多个变量进行了调整。对代谢综合征（体重指数≥30kg/m2、高血压和糖尿病）进行了亚组分析。通过 χ2 和 Mann-Whitney 检验比较了人口统计学和结果。
在 2927 例肝切除术中，30%（N=863）的患者有脂肪肝。中位体重指数为 28.6，6.3%（N=184）的患者存在代谢综合征。在倾向匹配后，比较了 863 例脂肪肝患者和 863 例正常肝脏患者。脂肪肝患者的多项结果明显较差（P<0.05），包括严重发病率（32%比 24%）、术后侵袭性胆道手术（15%比 10%）、器官空间感染（11%比 7.8%）和肺部并发症。脂肪肝和代谢综合征患者术后心脏骤停、肺栓塞和死亡率显著增加（P<0.05）。
脂肪肝疾病与重大肝切除术的结果明显较差相关。代谢综合征增加了术后死亡率的风险。
