Cosenza C A, Hoffman A L, Podesta L G, Sher L, Lopez R R, Lugo D, Makowka L
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Am Surg. 1995 Oct;61(10):889-95.
Although elderly patients are accounted for in all large series of major hepatic resections, the role of age as a determinant of outcome remains unclear. At Cedars-Sinai Medical Center, we review a series of 20 major hepatectomies for neoplasia performed in patients older than 66 years of age (4 of them > or = 80 years old) over a 5-year period. A retrospective comparison was conducted with a group of 22 hepatectomies for malignancy performed in 20 patients younger than 59 years of age during the same time period. The younger group had a significantly greater degree of liver resected (12 trisegmentectomies vs 3). Although one operative death (5% mortality) was observed in the elderly group, no statistically significant difference was noted, when compared to the younger group (Chi-square, P = 0.48). Likewise, no significant difference in the complication rate (20% vs 33%) was noticed (Chi-square, P = 0.8). Severe postoperative liver dysfunction was present in 2 cases (10%) in the elderly group and one (4%) in the younger group. These patients underwent a right trisegmentectomy (TS). Nine patients from each group were resected without red blood cell transfusion. We conclude that major hepatic resection in elderly patients without severe comorbid disease is a safe procedure that is not associated with an increased perioperative morbidity or mortality rate.
尽管在所有大型肝切除术系列研究中都纳入了老年患者，但年龄作为预后决定因素的作用仍不明确。在雪松西奈医疗中心，我们回顾了5年间为66岁以上患者（其中4例年龄≥80岁）实施的20例因肿瘤进行的大型肝切除术。同时对同期20例年龄小于59岁患者实施的22例恶性肿瘤肝切除术进行回顾性比较。年轻组切除的肝脏比例明显更高（12例三段肝切除术对3例）。尽管老年组观察到1例手术死亡（死亡率5%），但与年轻组相比，未发现统计学上的显著差异（卡方检验，P = 0.48）。同样，并发症发生率也无显著差异（20%对33%）（卡方检验，P = 0.8）。老年组2例（10%）和年轻组1例（4%）出现严重术后肝功能障碍。这些患者均接受了右三段肝切除术（TS）。每组9例患者在未输血情况下完成手术。我们得出结论，对于无严重合并症的老年患者，大型肝切除术是一种安全的手术，不会增加围手术期发病率或死亡率。
