目的:探讨肝腔合并病变患者术后死亡的短期预后及危险因素。
方法:我们回顾性分析了2012年1月至2016年1月在我们的肝脏外科中心接受肝切除术合并下腔静脉(IVC)和/或肝静脉重建(HVR)的54例连续患者。根据IVC和肝静脉受累的范围将患者分为5组。病人的细节,手术适应症,手术技术,比较5组患者的术中和术后结局.进行单因素和多因素分析以探索预测总体手术死亡的因素。
结果:37例(68.5%)患者进行了IVC置换,17例(31.5%)患者进行了HVR置换。I2H2型手术失血时间最长,手术时间和总肝脏缺血时间(所有,P<0.05)。三例I3H1型完全闭塞的IVC患者不需要IVC重建。术后总发病率为40.7%(22例),手术死亡率为16.7%(9例)。预测手术死亡的因素包括IVC替代(P=0.048)。肝缺血持续时间(P=0.005)和术前肝功能Child-PughB(P=0.025)。
结论:IVC更换,肝缺血持续时间和术前肝功能不良是预测术后死亡的危险因素。我们应该谨慎更换IVC,特别是在I2H2型。对于I3H1型,在建立侧支循环时无需更换IVC。
OBJECTIVE: to investigate the short-term outcomes and risk factors indicating postoperative death of patients with lesions adjacent to the hepatocaval confluence.
METHODS: We retrospectively analyzed 54 consecutive patients who underwent hepatectomy combined with inferior vena cava (IVC) and/or hepatic vein reconstruction (HVR) from January 2012 to January 2016 at our liver surgery center. The patients were divided into 5 groups according to the range of IVC and hepatic vein involvement. The patient details, indications for surgery, operative techniques, intra- and postoperative outcomes were compared among the 5 groups. Univariate and multivariate analyses were performed to explore factors predictive of overall operative death.
RESULTS: IVC replacement was carried out in 37 (68.5%) patients and HVR in 17 (31.5%) patients. Type I2H2 had the longest operative blood loss, operative duration and overall liver ischemic time (all, P < 0.05). Three patients of Type I3H1 with totally occluded IVC did not need IVC reconstruction. Total postoperative morbidity rate was 40.7% (22 patients) and the operative mortality rate was 16.7% (9 patients). Factors predictive of operative death included IVC replacement (P = 0.048), duration of liver ischemia (P = 0.005) and preoperative liver function being Child-Pugh B (P = 0.025).
CONCLUSIONS: IVC replacement, duration of liver ischemia and preoperative poor liver function were risk factors predictive of postoperative death. We should be cautious about IVC replacement, especially in Type I2H2. For Type I3H1, it was unnecessary to replace IVC when the collateral circulation was established.