微创化技术在精准肝切除中的应用

Surgical technique and concept in precise hepatectomy： experience of 338 cases of hepatectomy in single center

目的分析微创化技术对肝切除患者围手术期的影响。方法收集南京医科大学第一附属医院肝移植中心单个手术小组于2003年8月至2008年8月间所开展的338例肝切除手术患者的临床资料，分析应用微创化技术对患者术中出血量、并发症发生率、围手术期病死率的影响。结果338例肝切除术的病例中，255例（75．4％）患者进行解剖性肝叶或肝段的精准肝切除术。手术平均时间150min（45～650min）；术中出血量300ml（100～4600m1），211例（62．4％）术中未输血。围手术期总并发症发生率为18．1％，病死率为0．6％。多因素Logistic同归分析表明，围手术期输血和低帆小板血症足肝切除围手术期并发症发生的独立预后因子。结论体现微创化技术的精准肝切除术可使患者获得较好的临床结果，并发症发生率和病死率处于较低的水平。减少术中出血是获得围手术期良好临床结果的重要因素。

Objective To evaluate the perioperative clinical outcome and predictive factors for perioperative complication morbidity and mortality. Methods From August 2003 to August 2008, the data of 338 cases of hepatectomy performed in the liver transplant center of the First Affiliated Hospital of Nanjing Medical University was collected in a prospective manner. The patients＇ perioperative clinical risk factors and results were analyzed. Results In the 338 hepatectomy cases,255 patients （75.4%） underwent precise anatomical hepatectomy. The overall perioperative complication morbidity was 18.1% ,while the perioperative mortality was 0.6%. In a total of 211 （62.4%） cases, the operation was carried out without blood transfusion. Univariate analysis revealed that cirrhotic liver, thrombocytopeuia, blood loss in operation 〉 1000 ml, blood transfusion in operation and several other factors were closely related with the incidence rate of complication. Multivariate logistic regression analysis indicated that thrombocytopenia and perioperative blood transfusion were important independently predictive factors for the occurrence of perioperative complications in hepatectomy. Conclusions Precise hepatectomy enables patients to obtain better clinical outcome with low complication morbidity and perioperative mortality. Reducing hemorrhage is an important factor that lead to good clinical results.