Department of Liver Surgery and Transplantation, Liver Cancer Institute, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Zhongshan Hospital, 117948Fudan University, Shanghai, China.
Surg Innov. 2022 Apr;29(2):145-153. doi: 10.1177/15533506211018620. Epub 2021 May 15.
. Post-hepatectomy liver failure (PHLF) is an important cause of mortality and morbidity. Whether Child-Pugh A patients with varying degrees of cirrhosis are good candidates for hepatectomy is disputed. The purpose of this study was to analyze the impact of portal venous pressure gradient (PVPG) variation during surgery on PHLF. . PVPG, the pressure gradient between the portal vein and central vein, was measured in consecutive patients before and after liver resection. The optimal cutoff of PVPG to predict PHLF was determined by receiver operating characteristic curve analysis. Risk factors for PHLF were subjected to univariate and multivariable analysis. . Sixty Child-Pugh A patients were recruited. The mean PVPG was increased from 5.17 ± 4.78 mm of mercury (mmHg) to 6.37 ± 4.44 mmHg after liver resection. The optimal cutoff value of PVPG increments to predict PHLF was 1.5 mmHg. Multivariable analysis showed prothrombin time (PT), post-hepatectomy PVPG increments of 1.5 mmHg or greater, and resected liver segments of 3 or more to be independent predictors of PHLF. . Acute PVPG increase after hepatectomy is associated with a higher risk of PHLF in Child-Pugh A patients.
术后肝衰竭（PHLF）是导致死亡率和发病率的重要原因。是否患有不同程度肝硬化的 Child-Pugh A 患者适合进行肝切除术存在争议。本研究旨在分析手术过程中门静脉压力梯度（PVPG）变化对 PHLF 的影响。
连续测量了行肝切除术患者术前和术后的 PVPG。通过受试者工作特征曲线分析确定预测 PHLF 的最佳 PVPG 截断值。对 PHLF 的危险因素进行单因素和多因素分析。
共纳入 60 例 Child-Pugh A 患者。平均 PVPG 从 5.17±4.78 毫米汞柱（mmHg）增加至肝切除术后的 6.37±4.44mmHg。预测 PHLF 的最佳 PVPG 增量截断值为 1.5mmHg。多因素分析显示，凝血酶原时间（PT）、肝切除术后 1.5mmHg 或更高的 PVPG 增量以及 3 个或更多的切除肝段是 PHLF 的独立预测因素。
肝切除术后急性 PVPG 增加与 Child-Pugh A 患者 PHLF 的风险增加相关。
