Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy.
Department of General and Hepatobiliary Surgery, Verona University Hospital, Verona, Italy.
Ann Surg. 2023 Apr 1;277(4):e849-e855. doi: 10.1097/SLA.0000000000005536. Epub 2022 Jul 15.
To provide an overview of the current practice of intraoperative blood loss (BL) estimation in hepato-pancreato-biliary (HPB) surgery.
Intraoperative BL is a major quality marker in HPB surgery and a predictor of perioperative outcomes. However, the method for BL estimation is not standardized.
A systematic review was performed of original studies published between 2006 and 2021 reporting the intraoperative BL of patients undergoing pancreatic or hepatic resections. A web-based snapshot survey was distributed globally to all members of the International Hepato-Pancreato-Biliary Association (IHPBA).
A total of 806 studies were included; 480 (60%) had BL as their primary outcome, and 105 (13%) had BL as their secondary outcome. However, 669 (83%) did not specify how BL estimation was performed, and 9 different methods were found among the remaining 136 (17%) studies.The survey was completed by 252 surgeons. Most of the responders (94%) declared that they systematically performed BL estimation and considered BL predictive of postoperative complications after pancreatic (73%) and liver (74%) resection. All methods previously identified in the literature were used by responders with different frequencies. A calculation based on suction fluid amounts, operative gauze weight, and irrigation was the most used method in the literature (7%) and among responders (51%). Most responders (83%) felt that BL estimation in HPB surgery needs improved standardization.
Standardization of intraoperative BL estimation is urgently needed in HPB surgery to ensure the consistency of reporting and reproducibility.
概述肝胆胰外科手术中目前术中失血量（BL）估计的实践情况。
术中 BL 是肝胆胰外科手术中的一个主要质量指标，也是围手术期结果的预测因素。然而，BL 估计的方法尚未标准化。
对 2006 年至 2021 年间发表的报告胰腺或肝切除术患者术中 BL 的原始研究进行了系统回顾。全球范围内向国际肝胆胰协会（IHPBA）的所有成员分发了基于网络的快照调查。
共纳入 806 项研究；480 项（60%）将 BL 作为主要结局，105 项（13%）将 BL 作为次要结局。然而，669 项（83%）未具体说明 BL 估计是如何进行的，在其余 136 项（17%）研究中发现了 9 种不同的方法。该调查由 252 名外科医生完成。大多数应答者（94%）表示他们系统地进行 BL 估计，并认为 BL 可预测胰腺（73%）和肝脏（74%）切除术后的术后并发症。应答者使用了文献中先前确定的所有方法，但使用频率不同。基于吸液量、手术纱布重量和冲洗液的计算是文献中（7%）和应答者中（51%）最常用的方法。大多数应答者（83%）认为肝胆胰外科手术中的 BL 估计需要改进标准化。
肝胆胰外科手术中迫切需要 BL 估计的标准化，以确保报告的一致性和可重复性。
