Hayashi Hikaru, Shimizu Akira, Kubota Koji, Notake Tsuyoshi, Masuo Hitoshi, Yoshizawa Takahiro, Hosoda Kiyotaka, Sakai Hiroki, Yasukawa Koya, Soejima Yuji
Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan.
PLoS One. 2023 Oct 5;18(10):e0286353. doi: 10.1371/journal.pone.0286353. eCollection 2023.
Post-hepatectomy bile leakage (PHBL) is a potentially fatal complication that can arise after hepatectomy. Previous studies have identified obesity as a risk factor for PHBL. In this study, we investigated the impact of sarcopenic obesity on PHBL in hepatocellular carcinoma (HCC) patients.
In total, we enrolled 409 patients who underwent hepatectomy without bilioenteric anastomosis for HCC between January 2010 and August 2021. Patients were grouped according to the presence or absence of PHBL. Patient characteristics, including body mass index and sarcopenic obesity, were then analyzed for predictive factors for PHBL.
Among the 409 HCC patients included in the study, 39 developed PHBL. Male sex, hypertension, cardiac disease, white blood cell counts, the psoas muscle area, and visceral fat area, and intraoperative blood loss were significantly increased in the PHBL (+) group compared with the PHBL (-) group. Multivariate analysis showed that the independent risk factors for the occurrence of PHBL were intraoperative blood loss ≥370 mL and sarcopenic obesity.
Our results show that it is important to understand whether a patient is at high risk for PHBL prior to surgery and to focus on reducing intraoperative blood loss during surgery for patients with risk factors for PHBL.
肝切除术后胆漏（PHBL）是肝切除术后可能出现的致命并发症。既往研究已将肥胖确定为PHBL的一个危险因素。在本研究中，我们调查了肌肉减少性肥胖对肝细胞癌（HCC）患者PHBL的影响。
我们总共纳入了2010年1月至2021年8月期间因HCC接受无胆肠吻合术的肝切除术的409例患者。根据是否发生PHBL对患者进行分组。然后分析患者特征，包括体重指数和肌肉减少性肥胖，以寻找PHBL的预测因素。
在纳入研究的409例HCC患者中，39例发生了PHBL。与PHBL（-）组相比，PHBL（+）组的男性、高血压、心脏病、白细胞计数、腰大肌面积和内脏脂肪面积以及术中失血量显著增加。多因素分析显示，PHBL发生的独立危险因素是术中失血量≥370 mL和肌肉减少性肥胖。
我们的结果表明，在手术前了解患者是否有发生PHBL的高风险很重要，并且对于有PHBL危险因素的患者，在手术期间要着重减少术中失血量。
