Pantea Roxana, Meister Phil, Neuhaus Jan P, Nowak Knut, Paul Andreas, Saner Fuat H
Klinik für Allgemein‑, Viszeral-, und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstr 55, 45147, Essen, Deutschland.
Chirurg. 2021 Sep;92(9):838-845. doi: 10.1007/s00104-020-01319-z.
Patients with liver cirrhosis who are in need of surgery show a high in-hospital mortality. This study examined the risk of postoperative morbidity and in-hospital mortality after operations on patients with liver cirrhosis.
In the time period from January 2010 to December 2017 a total of 321 patients with liver cirrhosis underwent general surgery in this department. Liver-specific scoring systems, such as the Child-Pugh score (CPS) and MELD score were retrospectively assessed and correlated with in-hospital mortality and perioperative morbidity using the Dindo-Clavien classification.
Of the 321 patients (68% male) 21.2% underwent emergency surgery. These patients showed a mortality of 60%, which is significantly higher than in elective surgery (12%, p < 0.0001). Complex interventions showed a 41% mortality, minor interventions still 20.5% (p = 0.0001). The postoperative complication rate and mortality were significantly different sorted by CPS with 11.8%/6.3% in the CPS A category and 84%/73% in the CPS C category, respectively (p = 0.001). Statistically in-hospital mortality was increased by 20% for every point increase in the MELD score (odds ratio, OR 1.23, p = 0.0001). The presence of hepatic decompensation had the worst prognosis.
Surgical interventions in patients with liver cirrhosis are associated with a high complication rate and in-hospital mortality. The CPS and MELD scores can be used for objective risk assessment, while clinical examination for signs of hepatic decompensation is also important. Laboratory values, such as sodium and creatinine can assist the assessment.
需要手术治疗的肝硬化患者住院死亡率较高。本研究调查了肝硬化患者手术后的术后发病风险和住院死亡率。
2010年1月至2017年12月期间，该科室共有321例肝硬化患者接受了普通外科手术。回顾性评估了肝脏特异性评分系统，如Child-Pugh评分（CPS）和终末期肝病模型（MELD）评分，并使用Dindo-Clavien分类法将其与住院死亡率和围手术期发病率进行关联分析。
321例患者中（68%为男性），21.2%接受了急诊手术。这些患者的死亡率为60%，显著高于择期手术患者（12%，p<0.0001）。复杂手术的死亡率为41%，小手术的死亡率仍为20.5%（p=0.0001）。根据CPS分类，术后并发症发生率和死亡率有显著差异，CPS A类分别为11.8%/6.3%，CPS C类分别为84%/73%（p=0.001）。MELD评分每增加1分，住院死亡率统计学上增加20%（比值比，OR 1.23，p=0.0001）。存在肝失代偿的患者预后最差。
肝硬化患者的外科手术干预与高并发症发生率和住院死亡率相关。CPS和MELD评分可用于客观风险评估，同时对肝失代偿体征进行临床检查也很重要。钠和肌酐等实验室值有助于评估。
