Li Xinlin, Chen Kai, Feng Xu, Wu Xinhua, Qi Shiguai, Wang Qingmiao, Shi Zhengrong
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Chongqing, People's Republic of China.
Department of Obstetrics and Gynecology, The Fifth People's Hospital of Chongqing, Chongqing, Chongqing, People's Republic of China.
J Hepatocell Carcinoma. 2024 Oct 29;11:2101-2113. doi: 10.2147/JHC.S483397. eCollection 2024.
The purpose of This study is exploring the intraoperative and perioperative differences between patients undergoing conversion surgery and those undergoing direct surgery, so as to improve preoperative preparation.
The retrospective study was approved by an ethics review committee. A total of 232 patients with hepatocellular carcinoma who underwent surgical resection at the First Affiliated Hospital of Chongqing Medical University from September 2022 to December 2023 were included, comprising 210 operating patients and 53 conversion patients. Propensity score matching was employed for comparison in order to minimize bias.
The conversion group had more intraoperative bleeding (each P=0.001), longer operation time (P=0.033; PSM p=0.025), and higher intraoperative blood transfusion rate (p=0.001; PSM p=0.044). The incidence of perioperative complications, including perioperative ascites formation (p=0.011; PSM p=0.005), moderate to severe anemia (p=0.001; PSM p=0.002), postoperative blood transfusion (p=0.004; PSM p=0.036), and postoperative ICU transfer (p=0.041; PSM p=0.025), was higher in the conversion group compared to the operation group. The postoperative hospital stay (p=0.001; PSM p=0.003) was prolonged in the conversion group.
Post-conversion operations carry a higher risk of bleeding and are more likely to result in moderate to severe anemia and ascites formation in the perioperative period. However, the risk is reversible with adequate preoperative blood preparation and prompt postoperative symptomatic treatment. Conversion patients should be encouraged to undergo operating therapy when they can withstand surgical resection.
本研究旨在探讨中转手术患者与直接手术患者在术中及围手术期的差异，以改善术前准备。
本回顾性研究经伦理审查委员会批准。纳入2022年9月至2023年12月在重庆医科大学附属第一医院接受手术切除的232例肝细胞癌患者，其中手术患者210例，中转患者53例。采用倾向评分匹配法进行比较，以尽量减少偏倚。
中转组术中出血更多（各P = 0.001），手术时间更长（P = 0.033；倾向评分匹配后P = 0.025），术中输血率更高（P = 0.001；倾向评分匹配后P = 0.044）。中转组围手术期并发症的发生率高于手术组，包括围手术期腹水形成（P = 0.011；倾向评分匹配后P = 0.005）、中度至重度贫血（P = 0.001；倾向评分匹配后P = 0.002）、术后输血（P = 0.004；倾向评分匹配后P = 0.036）和术后转入重症监护病房（P = 0.041；倾向评分匹配后P = 0.025）。中转组术后住院时间延长（P = 0.001；倾向评分匹配后P = 0.003）。
中转手术后出血风险更高，围手术期更易出现中度至重度贫血和腹水形成。然而，通过充分的术前备血和及时的术后对症治疗，风险是可逆的。应鼓励中转患者在能够耐受手术切除时接受手术治疗。
