Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany.
BJS Open. 2024 Sep 3;8(5). doi: 10.1093/bjsopen/zrae110.
After major liver resections, anatomical shifts due to liver parenchymal hypertrophy and organ displacement can happen. The aim of this study was to evaluate the impact of these anatomical changes on the main abdominal arteries (coeliac trunk and superior mesenteric artery) and on patient outcomes.
All patients who underwent major liver resections (between January 2010 and July 2021) and who underwent preoperative and postoperative arterial-phase contrast-enhanced abdominal CT imaging were studied. Observed arterial position changes were classified into three groups: no position changes; class I position changes (vessel displacement with or without kinking with a vessel angle greater than 105°); and class II position changes (kinking less than or equal to 105°). The Mann-Whitney test and the Kruskal-Wallis test were used to compare continuous variables and the chi-squared test and Fisher's exact test were used to compare categorical variables. Univariable and multivariable logistic regression analyses were used to identify the risk factors for morbidity and mortality.
A total of 265 patients (149 men and median age of 59 years) were enrolled. Arterial position changes were detected in a total of 145 patients (54.7%) (99 patients (37%) with class I position changes and 46 patients (18%) with class II position changes) and were observed more often after extended resection and right-sided resection (P < 0.001). Major complications were seen in 94 patients (35%) and the rate of mortality was 15% (40 patients died). Post-hepatectomy liver failure (P = 0.030), major complications (P < 0.001), and mortality (P = 0.004) occurred more frequently in patients with class II position changes. In multivariable analysis, arterial position change was an independent risk factor for post-hepatectomy liver failure (OR 2.86 (95% c.i. 1.06 to 7.72); P = 0.038), major complications (OR 2.10 (95% c.i. 1.12 to 3.93); P = 0.020), and mortality (OR 2.39 (95% c.i. 1.03 to 5.56); P = 0.042).
Arterial position changes post-hepatectomy are observed in the majority of patients and are significantly related to postoperative morbidities and mortality.
在进行大肝切除术后，由于肝实质肥大和器官移位，可能会发生解剖移位。本研究的目的是评估这些解剖变化对主要腹部动脉（腹腔干和肠系膜上动脉）和患者预后的影响。
研究纳入了 2010 年 1 月至 2021 年 7 月期间接受大肝切除术且术前和术后均行动脉期增强腹部 CT 成像的所有患者。观察到的动脉位置变化分为三组：无位置变化；I 类位置变化（伴有或不伴有 105°以上的血管扭曲的血管移位）；II 类位置变化（扭曲小于或等于 105°）。采用 Mann-Whitney 检验和 Kruskal-Wallis 检验比较连续变量，采用卡方检验和 Fisher 确切检验比较分类变量。采用单变量和多变量逻辑回归分析确定发病率和死亡率的危险因素。
共纳入 265 例患者（149 例男性，中位年龄 59 岁）。共发现 145 例（54.7%）患者存在动脉位置变化（99 例（37%）为 I 类位置变化，46 例（18%）为 II 类位置变化），且在扩大切除术和右半肝切除术更为常见（P<0.001）。94 例（35%）患者出现重大并发症，死亡率为 15%（40 例死亡）。II 类位置变化患者的术后肝衰竭（P=0.030）、重大并发症（P<0.001）和死亡率（P=0.004）更为常见。多变量分析显示，动脉位置变化是术后肝衰竭（OR 2.86（95%可信区间 1.06 至 7.72）；P=0.038）、重大并发症（OR 2.10（95%可信区间 1.12 至 3.93）；P=0.020）和死亡率（OR 2.39（95%可信区间 1.03 至 5.56）；P=0.042）的独立危险因素。
术后肝切除术后动脉位置变化在大多数患者中均可见，与术后并发症和死亡率显著相关。
