肝脏良性病变切除术的安全性评估

Safety evaluation of hepatectomy for liver benign lesions

目的：评估肝良性疾病切除手术的安全性。方法：回顾性研究和分析中国人民解放军空军总医院与中国人民解放军总医院1986—2010年955例连续性肝切除手术病例。结果：955例中主要疾病是肝血管瘤和肝内胆管结石,分别占所有良性疾病的44.3%（423例）和27.8%（265例）。术中失血〈200mL者596例（62.4%）2,00~400mL者122例（12.8%）,401~1000mL者164例（17.2%）,〉1 000mL者73例（7.9%）。术中输异体血者359例（37.6%）,自体血回输者81例（8.5%）。手术时间平均（240.6±98.3）min。术后住院天数平均（13.6±9.4）d。术后并发症发生率为13.7%,围手术期病死率为0.21%。经多因素Logistic回归分析,与并发症相关的独立影响因素是手术时间（P=0.004,OR=1.003）和ALB值（P=0.040,OR=0.938）,其中手术时间的延长为危险因素,ALB值的升高为保护因素。结论：在重视优化围手术期处理和创新手术技术的前提下,能够使肝脏良性疾病的肝切除术保持低并发症发生率和低病死率,手术治疗安全可靠。

Objective： To evaluate the safety of hepatectomy for liver benign lesion.Methods： 955 consecutive liver benign lesions undergoing hepatectomy from January 1986 to December 2010 at Airforce General Hospital of Chinese PLA and General Hospital of Chinese PLA were investigated retrospectively according to their medical documentation.Results： Hemangioma and hepatolithiasis were listed in the first two in the our group,which accounted for 44.3%（423 cases） and 27.8%（265 cases） respectively.In all cases,those with blood loss less than 200 mL accounted for 62.4%（596cases）,201～400 mL accounted for 12.8%（122 cases）,401～1000 mL accounted for 17.2%（164 cases）,whereas those with more than 1000 mL accounted for 7.9%（73cases）.359（37.6%） required transfusion of blood products during operation,81cases were transfused with autoblood（8.48%）.The average operating time was（240.6±98.3）min,the average LOS after operation was（13.6±9.4）d.The postoperative complication rate was 13.7%,perioperative mortality was 0.21%.On multivariate analysis,the operating time（P=0.003,OR=1.013） and the value of ALB（P=0.035,OR=0.838）were independent predictors of morbidity.Conclusion： Hepatectomy of liver benign lesions can be performed safely with low mortality and low complication incidence,provided that it is carried out with optimized perioperative management and innovative surgical technique.