Abstract：
OBJECTIVE: An animal model of laparoscopic hepatectomy showed that bleeding from the hepatic vein is influenced by airway pressure. However, there are little research reports on how airway pressure leads to risks in clinical practice. The main objective of this study was to investigate the impact of preoperative forced expiratory volume % in 1 s (FEV1.0%) on intraoperative blood loss in laparoscopic hepatectomy.
METHODS: All patients who underwent pure laparoscopic or open hepatectomy from April 2011 to July 2020 were classified into two groups by preoperative spirometry: those with obstructive ventilatory impairment (obstructive group; FEV1.0% < 70%) and those with normal respiratory function (ormal group; FEV1.0% ≥ 70%). Massive blood loss was defined as 400 mL for laparoscopic hepatectomy.
RESULTS: In total, 247 and 445 patients underwent pure laparoscopic and open hepatectomy, respectively. Regarding laparoscopic hepatectomy group, blood loss was significantly greater in the obstructive group (122 vs. 100 mL, P = 0.042). Multivariate analysis revealed that high IWATE criteria which classify the surgical difficulty of laparoscopic hepatectomy (≥ 7, odds ratio (OR): 4.50, P = 0.004) and low preoperative FEV1.0% (< 70%, OR: 2.28, P = 0.043) were independent risk factors for blood loss during laparoscopic hepatectomy. In contrast, FEV1.0% did not affect the blood loss (522 vs. 605 mL, P = 0.113) during open hepatectomy.
CONCLUSIONS: Obstructive ventilatory impairment (low FEV1.0%) may affect the amount of bleeding during laparoscopic hepatectomy.
METHODS: All patients who underwent pure laparoscopic or open hepatectomy from April 2011 to July 2020 were classified into two groups by preoperative spirometry: those with obstructive ventilatory impairment (obstructive group; FEV1.0% < 70%) and those with normal respiratory function (ormal group; FEV1.0% ≥ 70%). Massive blood loss was defined as 400 mL for laparoscopic hepatectomy.
RESULTS: In total, 247 and 445 patients underwent pure laparoscopic and open hepatectomy, respectively. Regarding laparoscopic hepatectomy group, blood loss was significantly greater in the obstructive group (122 vs. 100 mL, P = 0.042). Multivariate analysis revealed that high IWATE criteria which classify the surgical difficulty of laparoscopic hepatectomy (≥ 7, odds ratio (OR): 4.50, P = 0.004) and low preoperative FEV1.0% (< 70%, OR: 2.28, P = 0.043) were independent risk factors for blood loss during laparoscopic hepatectomy. In contrast, FEV1.0% did not affect the blood loss (522 vs. 605 mL, P = 0.113) during open hepatectomy.
CONCLUSIONS: Obstructive ventilatory impairment (low FEV1.0%) may affect the amount of bleeding during laparoscopic hepatectomy.
摘要：
目的：腹腔镜肝切除术的动物模型显示，肝静脉出血受气道压力的影响。然而,关于气道压力在临床实践中如何导致风险的研究报道很少。本研究的主要目的是探讨术前用力呼气量%(FEV1.0%)对腹腔镜肝切除术术中出血量的影响。
方法：将2011年4月至2020年7月接受单纯腹腔镜或开腹肝切除术的所有患者根据术前肺活量测定分为两组：阻塞性通气障碍组（阻塞性组；FEV1.0%<70%）和呼吸功能正常组（正常组；FEV1.0%≥70%）。腹腔镜肝切除术的大量失血定义为400mL。
结果：总计，247例和445例患者接受了单纯腹腔镜和开腹肝切除术，分别。关于腹腔镜肝切除术组,阻塞性组的失血量明显更大（122vs.100mL,P=0.042)。多因素分析显示，高IWATE标准对腹腔镜肝切除术的手术难度（≥7，比值比（OR）：4.50，P=0.004）和低的术前FEV1.0％（<70％，OR：2.28，P=0.043）是腹腔镜肝切除术中失血的独立危险因素。相比之下,FEV1.0%不影响失血（522vs.605毫升,开放式肝切除术中P=0.113）。
结论：阻塞性通气障碍（低FEV1.0%）可能影响腹腔镜肝切除术中的出血量。
方法：将2011年4月至2020年7月接受单纯腹腔镜或开腹肝切除术的所有患者根据术前肺活量测定分为两组：阻塞性通气障碍组（阻塞性组；FEV1.0%<70%）和呼吸功能正常组（正常组；FEV1.0%≥70%）。腹腔镜肝切除术的大量失血定义为400mL。
结果：总计，247例和445例患者接受了单纯腹腔镜和开腹肝切除术，分别。关于腹腔镜肝切除术组,阻塞性组的失血量明显更大（122vs.100mL,P=0.042)。多因素分析显示，高IWATE标准对腹腔镜肝切除术的手术难度（≥7，比值比（OR）：4.50，P=0.004）和低的术前FEV1.0％（<70％，OR：2.28，P=0.043）是腹腔镜肝切除术中失血的独立危险因素。相比之下,FEV1.0%不影响失血（522vs.605毫升,开放式肝切除术中P=0.113）。
结论：阻塞性通气障碍（低FEV1.0%）可能影响腹腔镜肝切除术中的出血量。
