肝癌切除术后并发症的多元回归分析

目的研宛与肝癌切除术后并发症发生有关的因素，并探讨减少肝癌切除术后并发症的技术要点。方法回顾性总结1988年6月至2005年4月间连续施行的378例肝癌切除病例，采用单因素分析和多元退步回归模型分析与肝癌切除术后并发症有关的因素。结果肝癌切除术后总的并发症发生率为17．7％，手术死亡率为1．3％。单因素分析显示，年龄、肝门阻断、出血量以及术中输血等4项指标与并发症发生有关。多元逐步回归分析显示年龄、肝门阻断和术中输血这3项指标是决定肝癌切除术后并发症发生的独立的危险因素。结论降低肝癌切除术后并发症发生率的关键在于术中有效地控制出血厦输血量，同时对伴存肝硬化的病人应尽量缩短肝门阻断时间。     

不阻断肝门的大肝癌切除术

目的 研究不阻断肝门的肝切除术在大肝癌切除手术中的价值。方法 回顾性分析30例不阻断肝门的大肝癌切除术，并与同期98例采用肝门阻断的大肝癌切除术做对比。采用单因素和多因素分析的方法，研究与大肝癌术后并发症有关的因素。结果 不阻断肝门组术后并发症率低于阻断肝门组(10．0％vs32．7％，P＝0．02)。单因素分析显示年龄、肝门阻断、术中出血量、输血量以及手术时间等与并发症发生有关，进一步通过多元逐步回归模型分析发现，年龄、肝门阻断、输血量以及手术时间是决定术后并发症发生的4个独立的预测指标。结论 大肝癌切除手术中有选择性地采用不阻断肝门的肝切除技术是安全可行的。     

Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma

BACKGROUND: Extended hepatectomy with resection of more than four segments is a high-risk operation, especially in patients with hepatocellular carcinoma (HCC) associated with chronic liver disease. This study evaluated the risk factors for morbidity and mortality following extended hepatectomy for HCC. METHODS: Preoperative and intraoperative variables of 155 patients who underwent extended hepatectomy for HCC were analysed to identify risk factors for postoperative morbidity and mortality. RESULTS: The overall morbidity rate was 55.5 per cent (n = 86). Most morbidity was due to ascites or pleural effusion. Significant life-threatening complications occurred in 20.0 per cent (n = 31). The perioperative mortality rate was 8.4 per cent (n = 13). Multivariate analysis found that portal clamping (P = 0.023) and perioperative blood transfusion (P < 0.001) were risk factors for morbidity, whereas perioperative blood transfusion (P < 0.001) was the only risk factor for significant morbidity. Co-morbid illness (P = 0.019) and perioperative blood transfusion (P = 0.004) were risk factors for perioperative mortality. CONCLUSION: Meticulous operative techniques to minimize blood loss and transfusion, while avoiding a prolonged Pringle manoeuvre, may help reduce postoperative morbidity. Avoidance of perioperative blood transfusion and careful preoperative selection of patients in terms of overall physiological status are important measures to reduce the postoperative mortality rate.     

Hassab术后并发症的相关因素分析

目的 对Hassab术后并发症的相关因素进行分析。方法 回顾性分析186例Hassab术患者的临床资料。采用单因素和多元回归模型分析与Hassab术后并发症的相关因素。结果Hassab术后并发症发生率为22.6％,手术死亡率为 3.23％。单因素分析显示年龄、肝功能分级、断流后门静脉压力、术中出血量、术中输血量与并发症发生有关。多元回归分析显示年龄、肝功能分级、断流后门静脉压力、术中输血量是Hassab术后并发症发生的独立危险因素。认为对肝功能好、年龄小、断流后门脉压力<35cmH2O者,术中行精细操作,手术效果好;对于断流后门脉压力仍>35cmH2O的患者,应加行分流术。     

输血对大肝癌切除术后近远期预后的影响

目的研究输血对大肝癌切除术后近期并发症和远期存活率的影响。方法回顾性分析177例大肝癌切除术病例，结合随访分析输血对近期并发症和远期存活率的影响。结果本组大肝癌围手术期输血率为74．6％。近5年输血量及输血率较5年前显著减少（P〈0．01）。不输血组并发症率低于输血组（P〈0．05）。单因素分析显示，年龄、肝门阻断、术中出血量、输血量以及手术时间与术后并发症发生有关。多因素分析显示，年龄、肝门阻断、输血量以及手术时间是决定术后并发症的4个独立的预测指标。本组大肝癌1、3、5年总存活率为67％、44％和34％，1、3、5年无瘤存活率为51％、31％和31％。不输血组和输血组的总存活率以及无瘤存活率无显著差别。结论输血是决定大肝癌切除术后并发症发生的独立危险因素之一，但输血对大肝癌切除术后存活率无显著影响。肝脏外科医生应积极采取各种方法尽可能避免大肝癌切除术围手术期的输血。     

大肝癌手术切除术中不同肝血流阻断方法的临床研究

目的：比较大肝癌手术切除术中3种不同的入肝血流阻断法的临床效果。
　　方法：回顾性分析2011年1月—2013年3月期间218例大肝癌（>5cm）手术患者的临床资料,术中88例采用Pringle法间断阻断全肝血流（肝门阻断组）,51例行选择性的半肝血流阻断（半肝阻断组）,79例行肝下下腔静脉阻断联合Pringle法阻断入肝血流（联合阻断组）。比较3组患者的术中与术后的相关指标。
　　结果：3组患者的术前情况、手术时间、入肝血流阻断时间及肝切除量的差异均无统计学意义（均P>0.05）;半肝阻断组与联合阻断组的术中出血量、输血量、输血率均明显低于肝门阻断组,且联合阻断组的输血量、输血率明显低于半肝阻断组（均P<0.05）;3组患者术后第1天肝功能指标差异无统计学意义（均P>0.05）,但半肝阻断组与联合阻断组第3、7天的转氨酶和总胆红素水平均明显低于肝门阻断组（均P<0.05）;3组术后并发症的发生率差异无统计学意义（P>0.05）。
　　结论：大肝癌切除术术中采用肝下下腔静脉阻断联合Pringle法阻断入肝血流不仅能够有效减少术中失血量,而且有利于术后肝功能的恢复。     

Intra-operative Blood Loss Predicts Complications After a Second Hepatectomy for Malignant Neoplasms

Objective We investigated the risk of morbidity after repeat resections for liver recurrence of hepatocellular carcinoma or for colorectal liver metastases. Background Data Although repeat hepatectomy for recurrences of hepatocellular carcinoma or for colorectal cancer liver metastases is well known only to carry risks similar to those seen for an initial liver resection, the safety of such a procedure is questionable because, typically, only a few liver tumors are thought suitable for repeat hepatectomy. Methods Clinicopathology data were available for 412 hepatectomy patients (hepatocellular carcinoma in 226, colorectal liver metastases in 186). Risk factors for postoperative complications were analyzed retrospectively among the 57 patients undergoing a repeat hepatectomy. Results Using multivariate analysis, intraoperative blood loss (relative risk, 9.61; P = 0.02) affected the occurrence of postoperative complications after a second hepatectomy. In patients who lost more than 1.29 l blood intraoperatively at the second hepatectomy, a major hepatectomy (P < 0.05) by means of an anatomical type of resection (P < 0.01) was more often performed than in the patients with 1.29 l or less of blood loss. Conclusions The major independent risk factor associated with complications after a second hepatectomy for liver recurrence was intraoperative blood loss. The extent of liver resection, especially in an anatomical manner, directly influences the amount of blood loss.     

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??Intrahepatic Glissonian approach for mesohepatectomy in the management of primary hepatic tumors HU Ji-xiong??DAI Wei-dong??MIAO Xiong-ying??et al. Department of Hepatobiliary Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China Corresponding author??DAI Wei-dong??E-mail:daiweidong@medmail.com.cn Abstract Objective To evalualte intrahepatic Glissonian approach for mesohepatectomy in the management of primary hepatic tumors. Methods The clinical data of 24 cirrhotic patients with primary liver tumor admitted from May 2005 to December 2007 at the Second Xiangya Hospital of Central South University were analyzed retrospectively. Results Mesohepatectomy was feasible with the proposed technique in all patients. No patients experienced massive bleeding during the operation. The estimated intraoperative mean amount of blood loss was 300mL (range 200 to 1200mL). The mean operating time was ??258±60?? minutes and only 2 patients required blood transfusion for 2U. Minor postoperative complications included bile leakage in 3 cases, subphrenic infection in 2 cases and resolved with conservative management. No hospital mortality occurred. Conclusion Intrahepatic Glissonian access for mesohepatectomy in cirrhotic patients is safe and effective. It may reduce intraoperative blood loss and the need for the pringle maneuver.     

Negative Impact of Blood Transfusion on Recurrence and Prognosis of Hepatocellular Carcinoma After Hepatic Resection

Background  In perioperative management of hepatic resection for hepatocellular carcinoma, excessive blood loss and blood transfusion greatly influence postoperative complications and prognosis of the patients. We evaluated the influence of blood products use on postoperative recurrence and prognosis of patients with hepatocellular carcinoma. Methods  The subjects were 66 patients who underwent elective hepatic resection for hepatocellular carcinoma without concomitant microwave or radiofrequency ablation therapy nor other malignancies between January 2001 and June 2006. We retrospectively investigated the influence of the use of blood products including red cell concentration and fresh frozen plasma on recurrence of hepatocellular carcinoma and overall survival. Results  In multivariate analysis, the dose of blood products transfusion was a significant predictor of disease-free and overall survival. Both disease-free and overall survival rates of those who were given blood products were significantly worse than those who did not receive. On the other hand, in univariate analysis of disease-free and overall survival after hepatic resection and clinical variables, the amount of blood loss was not a significant predictor of recurrence or death. Conclusion  Transfusion of blood products is associated with increased recurrence rate and worse survival after elective hepatic resection for patients with hepatocellular carcinoma.     

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??Risk factors for early postoperative complication after ileal/ileocecal resection for chronic radiation enteritis with small bowel obstruction GONG Jian-feng, ZHU Wei-ming, YU Wen-kui, et al. Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command PLA, Medical College of Nanjing University, Nanjing 210002, China
Corresponding author ??LI Ning, E-mail: liningrigs@yahoo.com.cn
Abstract Objective To identify the perioperative complication incidence and its risk factors in patients underwent ileal/ileocecal resection for chronic radiation enteritis (CRE) with small bowel obstruction. Methods Univariate and multivariate analysis of a retrospectively gathered database between June 2001 and December 2011 in Department of General Surgery, Nanjing General Hospital of Nanjing Military Command PLA were performed on a cohort of patients (n=158) underwent ileal/ileocecal resection for CRE obstruction at a single institution. Altogether, we analyzed 33 potential risk factors to identify significant influence on the postoperative outcome. Results Overall and major morbidity rates were 57.0% (90 patients) and 28.5% (45 patients), respectively. The mortality rate was 1.9% (3 patients). Univariate analysis determined that ASA score of not less than 3, anemia, low platelet level, long operation time, intraoperative transfusion, presence of radiation uropathy and proctitis and experience of surgeons were important risk factors for Grade ??-?? morbidity. Multivariate analysis found ASA score of not less than 3, anemia, intraoperative transfusion, low platelet level, radiation uropathy and surgeon’s experience as independent risk factors for Grade ??-?? morbidity. Conclusion The current study provides the first evidence of predictive risk factors for postoperative morbidity of ileal/ileocecal resection for CRE.