Department of Gastroenterological and Transplant Surgery, School of Biomedical and Health Sciences Hiroshima University, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
Division of Regeneration and Medicine,, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
BMC Surg. 2023 Apr 11;23(1):86. doi: 10.1186/s12893-023-01986-9.
The rate of postoperative morbidity, including infectious complications, is still high after major hepatobiliary pancreatic (HBP) surgery. Although surgery-related disseminated intravascular coagulation (DIC) occurs in some cases, its significance has not been elucidated in HBP surgery. This study aimed to evaluate the influence of surgery-related DIC on the complication severity after HBP surgery.
We analyzed the records of 100 patients with hepatectomy in two or more segments, hepatectomy with biliary tract reconstruction, and pancreaticoduodenectomy. The baseline characteristics and complications were compared between patients with and without surgery-related DIC on postoperative day 1 (POD1) after HBP surgery between 2010 and 2018. Complication severity was assessed using the Comprehensive Complication Index (CCI).
The DIC group (surgery-related DIC on POD1) had predictive factors, such as larger bleeding volume and higher liver enzyme levels. The DIC group exhibited significantly elevated rates of surgical site infection, sepsis, prolonged intensive care unit stay, more frequent blood transfusions, and higher CCI. Furthermore, compared with and without adjustment of DIC, odds ratio (OR) of AST level and operation time for the risk of high CCI decreased (OR of AST level: 1.25 to 1.19 and OR of operation time: 1.30 to 1.23) and the significant differences had vanished.
Surgery-related DIC on POD1 could be a partial mediator between AST level, operation time and higher CCI. The prevention or proper management of surgery-related DIC on POD1 can be an important target to reduce the severity of postoperative complications.
在进行重大肝胆胰（HBP）手术后，包括感染性并发症在内的术后发病率仍然很高。尽管在某些情况下会发生与手术相关的弥漫性血管内凝血（DIC），但其在 HBP 手术中的意义尚未阐明。本研究旨在评估与手术相关的 DIC 对 HBP 手术后并发症严重程度的影响。
我们分析了 2010 年至 2018 年间 100 例接受两叶以上肝切除术、胆道重建肝切除术和胰十二指肠切除术的患者记录。比较了 HBP 手术后第 1 天（POD1）存在与不存在与手术相关的 DIC 的患者的基线特征和并发症。使用综合并发症指数（CCI）评估并发症严重程度。
DIC 组（POD1 存在与手术相关的 DIC）存在预测因素，如出血量较大和肝酶水平较高。DIC 组手术部位感染、败血症、延长重症监护病房停留时间、更频繁的输血和更高的 CCI 发生率显著升高。此外，与不调整 DIC 相比，AST 水平和手术时间对高 CCI 的风险的比值比（OR）降低（AST 水平的 OR：1.25 降至 1.19 和手术时间的 OR：1.30 降至 1.23），显著差异消失。
POD1 与手术相关的 DIC 可能是 AST 水平、手术时间和更高 CCI 之间的部分中介。预防或适当管理 POD1 与手术相关的 DIC 可能是降低术后并发症严重程度的重要目标。
