Tang Liang, Chen Ling-Xi, Luo Chu-Chu, Zhao Yuan
Department of Anesthesiology, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha 410000, Hunan Province, China.
Department of Cardiology, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha 410000, Hunan Province, China.
World J Gastrointest Surg. 2025 May 27;17(5):102335. doi: 10.4240/wjgs.v17.i5.102335.
Post-hepatectomy liver failure (PHLF), represents a serious complication after liver resection, significantly impacting the long-term outcomes for patients who undergo such surgeries. There exists a strong correlation between intraoperative hemorrhage and transfusion requirements with the development of PHLF. Presently, a combination of hepatic portal occlusion techniques alongside controlled low central venous pressure (CLCVP) methodologies is extensively employed to mitigate intraoperative bleeding. Nonetheless, limited studies have analyzed the risk factors for PHLF under CLCVP.
To develop and validate a nomogram that predicts the risk factors associated with the development of PHLF patients undergoing liver resection with CLCVP.
We conducted a retrospective analysis of 285 patients who underwent hepatectomy for the first time and had no history of prior non-index abdominal surgeries, with hepatic inflow occlusion combined with CLCVP from January to December 2019 in Hunan Provincial People's Hospital. Univariate and multivariate regression analyses were used to identify preoperative and intraoperative risk factors for PHLF. Eligible patients were randomly divided into training and validation groups in a 7:3 ratio, and a nomogram prediction model was constructed.
The incidence of PHLF in these patients was 22.46%. Multiple logistic analysis showed that preoperative serum albumin level, causes of liver resection (cancer or others), and cirrhosis were independent preoperative risk factors for PHLF ( < 0.05) and that only post-blocking blood potassium concentration was an independent intraoperative risk factor for PHLF ( < 0.05). Least absolute shrinkage and selection operator regression analysis revealed that preoperative serum albumin level, direct bilirubin level (DBIL), platelet count, causes of liver resection (cancer or others), and cirrhosis were significant predictors of PHLF. The nomogram risk prediction model based on preoperative serum albumin level, DBIL, platelet count, causes of liver resection (cancer or others), cirrhosis and post-blocking blood potassium concentration can better predict the occurrence of PHLF.
For patients undergoing liver resection with CLCVP, serum albumin level, DBIL, platelet count, causes of liver resection (cancer or others), and cirrhosis are independent preoperative risk factors for PHLF.
肝切除术后肝衰竭（PHLF）是肝切除术后的一种严重并发症，对接受此类手术的患者的长期预后有重大影响。术中出血和输血需求与PHLF的发生之间存在密切关联。目前，肝门静脉阻断技术与控制性低中心静脉压（CLCVP）方法联合广泛用于减少术中出血。然而，关于CLCVP下PHLF危险因素的研究有限。
建立并验证一个列线图，以预测接受CLCVP肝切除术的患者发生PHLF的相关危险因素。
我们对2019年1月至12月在湖南省人民医院首次接受肝切除术且无既往非索引腹部手术史、采用肝血流阻断联合CLCVP的285例患者进行了回顾性分析。采用单因素和多因素回归分析确定PHLF的术前和术中危险因素。符合条件的患者按7:3的比例随机分为训练组和验证组，并构建列线图预测模型。
这些患者中PHLF的发生率为22.46%。多因素logistic分析显示，术前血清白蛋白水平、肝切除原因（癌症或其他）和肝硬化是PHLF的独立术前危险因素（<0.05），且仅阻断后血钾浓度是PHLF的独立术中危险因素（<0.05）。最小绝对收缩和选择算子回归分析显示，术前血清白蛋白水平、直接胆红素水平（DBIL）、血小板计数、肝切除原因（癌症或其他）和肝硬化是PHLF的重要预测因素。基于术前血清白蛋白水平、DBIL、血小板计数、肝切除原因（癌症或其他）、肝硬化和阻断后血钾浓度的列线图风险预测模型能更好地预测PHLF的发生。
对于接受CLCVP肝切除术的患者，血清白蛋白水平、DBIL、血小板计数、肝切除原因（癌症或其他）和肝硬化是PHLF的独立术前危险因素。
