24年肝脏良性病变切除术955例回顾性分析

Resection of benign liver lesions in the past 24 years:A retrospective analysis of 955 consecutive cases

目的分析与肝良性疾病切除术相关的手术期和围手术期因素,对该手术的安全性进行评估。方法回顾性分析空军总医院与解放军总医院1986-2010年955例连续性肝切除手术病例。结果本组数最多的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27.7%(265例)。术中失血≤200ml 596例(62.41%),200-400ml 122例(12.77%),400-1 000ml 164例(17.17%),>1 000ml 73例(7.86%)。术中输异体血359例(37.59%),自体血回输81例(8.48%)。平均手术时间(240.60±98.31)min。术后平均住院天数(14.01±8.23)d。总术后并发症发生率13.72%,围手术期死亡率0.21%。经多因素Logistic回归分析,与并发症相关的独立危险因素是手术时间(P=0.003,OR=1.013),血清白蛋白值升高为保护因素(P=0.035,OR=0.838)。结论重视围手术期处理和手术技术创新,肝良性疾病切除术是安全的,能够保持低并发症发生率和低死亡率。

Objective To analyze the operative and peri-operative factors related with resection of benign liver lesions and evaluate its reliability.Methods A total of 955 consecutive patients who underwent resection of benign liver lesions from January 1986 to December 2010 in Chinese PLA Air force General Hospital and Chinese PLA General Hospital were retrospectively analyzed.Results Hemangioma and hepatolithiasis were the most commonly encountered diseases in clinical practice,accounting for 44.3% of 423 patients and 27.7% of 265 patients with benign liver lesions.The blood loss was≤200ml in 596 cases（62.41%）,200-400ml in 122 cases（12.77%）,400-1 000ml in 164 cases（17.17%）,〉1 000ml in 73 cases（7.86%）.Three hundred and fifty-nine cases（37.59%） required transfusion of blood products during operation,81 cases（8.48%） were transfused with autoblood.The average operation time was（240.60±98.31）minutes,the average hospital stay time was（14.01±8.23）days after operation.The incidence of complications after operation was 13.72% and the peri-operative mortality was 0.21%.Multivariate analysis showed that the operation time was an independent factor for complications（P=0.003,OR=1.013） while the increased ALB was a protective factor for complications（P=0.035,OR=0.838）.Conclusion Resection of benign liver lesions is a safe procedure with a low incidence of death and complications when importance is attached to peri-operative management and innovation of surgical technique.