Benoist S, Gailleton R, Gayral F
Service de Chirurgie générale et digestive, CHU de Bicêtre, Le Kremlin Bicêtre.
Ann Chir. 1995;49(7):589-95.
Charts of 100 consecutive patients who had undergone liver resection, performed by a single surgeon, during the 10 year period from 1983 to 1993 were reviewed. Liver trauma was excluded. The age of the patients ranged from 14 to 78 years, with a mean age of 52 +/- 12.3. Indications for liver resection were malignant tumors in 73 patients and benign disease in another 27 patients. The remnant liver was pathologic in 24 cases (21 cirrhosis, 3 chronic hepatitis). The extent of liver resection was major (> 3 segments) in 51 cases, and minor in 45 cases. Postoperative complications, including death, occurred in 24% of cases. Five complications required reoperation. Hospital mortality was 4%. Multivariate analysis demonstrated two major risk factors of morbidity: intraoperative blood transfusion, and cirrhosis. Age of patients was the only risk factor of mortality. In major resection, four categories of patients were established according to the type of hepatic inflow occlusion. Each group was comparable. Selective vascular clamping (selective control of the hilar vessels to the liver and selective hepatic vein occlusion) decreased the morbidity and post operative liver failure rate (p < 0.05). On the other hand, no correlation was observed between the type of hepatic inflow occlusion and the hospital mortality.
回顾了1983年至1993年期间由一名外科医生实施肝切除术的100例连续患者的病历。排除肝外伤患者。患者年龄在14岁至78岁之间，平均年龄为52±12.3岁。肝切除的指征为73例恶性肿瘤和另外27例良性疾病。24例患者的残余肝脏存在病理改变（21例肝硬化，3例慢性肝炎）。肝切除范围为大手术（>3个肝段）的有51例，小手术的有45例。术后并发症（包括死亡）发生率为24%。5例并发症需要再次手术。医院死亡率为4%。多因素分析显示发病的两个主要危险因素为术中输血和肝硬化。患者年龄是死亡的唯一危险因素。在大手术中，根据肝血流阻断类型确定了四类患者。每组具有可比性。选择性血管钳夹（选择性控制入肝门血管和选择性肝静脉阻断）降低了发病率和术后肝衰竭发生率（p<0.05）。另一方面，未观察到肝血流阻断类型与医院死亡率之间存在相关性。
