肝切除术中出血量对患者预后的影响：单中心经验。
Effects of intraoperative blood loss during liver resection on patients’ outcome: a single- center experience.
机构信息
Department of Surgery, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
Department of Radiology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
出版信息
Turk J Med Sci. 2021 Jun 28;51(3):1388-1395. doi: 10.3906/sag-2008-78.
BACKGROUND/AIM: Operative bleeding is one of the major determinants of outcome in liver surgery. This study aimed to describe the impact of intraoperative blood loss on the postoperative course of liver resection (LR).
MATERIALS AND METHODS
The data of 257 patients who were treated with LR between January 2007 and October 2018 were retrospectively analyzed. LRs were performed via intermittent portal triad clamping (PTC) under low central venous pressure.
RESULTS
LRs were performed for 67.7% of patients with a malignant disease and 32.3% of patients with a benign disease. Major LR was performed in 89 patients (34.6%). The mean PTC period was 20.32 min (±13.7). The median intraoperative bleeding amount was 200 mL (5–3500 mL), the 30-day mortality rate was 4.3%, and the morbidity rate was 31.9%. The hospital stay (p = 0.002), morbidity (p = 0.009), and 30-day mortality (p = 0.041) of patients with a bleeding amount of more than 500 mL significantly increased.
CONCLUSION
Surgeons should consider the adverse effects of intraoperative bleeding during liver resection on patients’ outcome. Favorable outcomes would be obtained with diligent postoperative care.
背景/目的：术中出血是肝外科手术结果的主要决定因素之一。本研究旨在描述术中出血量对肝切除（LR）术后过程的影响。
材料和方法
回顾性分析了 2007 年 1 月至 2018 年 10 月期间接受 LR 治疗的 257 例患者的数据。LR 通过低中心静脉压下间歇性门静脉三联夹闭（PTC）进行。
结果
67.7%的患者因恶性疾病而行 LR，32.3%的患者因良性疾病而行 LR。89 例（34.6%）行主要 LR。平均 PTC 时间为 20.32 分钟（±13.7）。术中出血量中位数为 200 毫升（5-3500 毫升），30 天死亡率为 4.3%，发病率为 31.9%。出血量超过 500 毫升的患者的住院时间（p = 0.002）、发病率（p = 0.009）和 30 天死亡率（p = 0.041）显著增加。
结论
外科医生在进行肝切除时应考虑术中出血对患者预后的不利影响。通过精心的术后护理，可以获得良好的结果。
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