Brancatisano R, Isla A, Habib N
Department of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London, United Kingdom.
Am J Surg. 1998 Feb;175(2):161-3. doi: 10.1016/S0002-9610(97)00265-1.
A prospective review of 200 consecutive liver resections performed for benign and malignant disease, between 1989 and 1995 at the Hammersmith Hospital, was undertaken to evaluate the safety of radical hepatic resection.
The indications for operation were: hepatocellular carcinoma (n = 39), cholangiocarcinoma (n = 21), gall bladder carcinoma (n = 8), colorectal secondaries (n = 75), noncolorectal secondaries (n = 35), and benign disease (n = 26). Twenty patients were cirrhotic and 36 were jaundiced. Major resections were performed in 74% of cases and included 63 extended hepatectomies, 17 repeated resections for recurrent colorectal metastases, and 17 resections combined with vascular reconstruction. Total vascular exclusion of the liver was used in the majority of cases.
The overall mortality rate was 5%. Thirty-day mortality was 2.5%. Sepsis and not hemorrhage was the most common cause of death. There were 101 complications that occurred in 37% of the patients. The main complications were subphrenic abscess and biliary leak. The extent of liver resection (major versus minor) significantly increased the risk of morbidity (46% versus 16%). Blood loss greater than 100 mL increased the risk of morbidity from 12% to 25%.
Major hepatic resection can be achieved with acceptable mortality but high morbidity rates.
对1989年至1995年间在哈默史密斯医院因良性和恶性疾病进行的连续200例肝切除术进行前瞻性回顾，以评估根治性肝切除术的安全性。
手术指征为：肝细胞癌（n = 39）、胆管癌（n = 21）、胆囊癌（n = 8）、结直肠癌转移灶（n = 75）、非结直肠癌转移灶（n = 35）和良性疾病（n = 26）。20例患者有肝硬化，36例有黄疸。74%的病例进行了大手术，包括63例扩大肝切除术、17例因复发性结直肠癌转移而进行的重复切除术以及17例联合血管重建的切除术。大多数病例采用了全肝血管阻断。
总死亡率为5%。30天死亡率为2.5%。脓毒症而非出血是最常见的死亡原因。37%的患者发生了101例并发症。主要并发症为膈下脓肿和胆漏。肝切除范围（大手术与小手术）显著增加了发病风险（46%对16%）。失血量大于100 mL使发病风险从12%增加到25%。
根治性肝切除术可以在可接受的死亡率下完成，但发病率较高。
