肝脏大部切除术后动脉位置变化新描述的结果:回顾性研究。

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae110
Sepehr Abbasi Dezfouli, Arash Dooghaie Moghadam, Philipp Mayer, Miriam Klauss, Hans-Ulrich Kauczor, De-Hua Chang, Mohammad Golriz, Arianeb Mehrabi, Katharina Hellbach
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引用次数: 0

摘要

背景:肝脏大部切除术后,肝实质肥大和器官移位会导致解剖结构的改变。本研究旨在评估这些解剖变化对腹部主要动脉(腹腔干和肠系膜上动脉)的影响以及对患者预后的影响:研究对象为所有接受肝脏大部切除术的患者(2010年1月至2021年7月期间),这些患者均接受了术前和术后动脉相对比增强腹部CT成像检查。观察到的动脉位置变化分为三组:无位置变化;I类位置变化(血管移位伴或不伴扭结,血管角度大于105°);II类位置变化(扭结小于或等于105°)。连续变量的比较采用 Mann-Whitney 检验和 Kruskal-Wallis 检验,分类变量的比较采用卡方检验和费雪精确检验。采用单变量和多变量逻辑回归分析来确定发病率和死亡率的风险因素:共纳入 265 名患者(149 名男性,中位年龄为 59 岁)。共有 145 名患者(54.7%)发现动脉位置改变(99 名患者(37%)为 I 级位置改变,46 名患者(18%)为 II 级位置改变),扩大切除术和右侧切除术后更常观察到动脉位置改变(P < 0.001)。94名患者(35%)出现主要并发症,死亡率为15%(40名患者死亡)。肝切除术后肝功能衰竭(P = 0.030)、主要并发症(P < 0.001)和死亡率(P = 0.004)更多地发生在 II 级体位改变的患者中。在多变量分析中,动脉位置改变是肝切除术后肝衰竭(OR 2.86(95% 置信区间 1.06 至 7.72);P = 0.038)、主要并发症(OR 2.10(95% 置信区间 1.12 至 3.93);P = 0.020)和死亡率(OR 2.39(95% 置信区间 1.03 至 5.56);P = 0.042)的独立风险因素:结论:大多数患者在肝切除术后会出现动脉位置变化,这与术后发病率和死亡率有显著关系。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outcome of the novel description of arterial position changes after major liver resections: retrospective study.

Background: After major liver resections, anatomical shifts due to liver parenchymal hypertrophy and organ displacement can happen. The aim of this study was to evaluate the impact of these anatomical changes on the main abdominal arteries (coeliac trunk and superior mesenteric artery) and on patient outcomes.

Methods: All patients who underwent major liver resections (between January 2010 and July 2021) and who underwent preoperative and postoperative arterial-phase contrast-enhanced abdominal CT imaging were studied. Observed arterial position changes were classified into three groups: no position changes; class I position changes (vessel displacement with or without kinking with a vessel angle greater than 105°); and class II position changes (kinking less than or equal to 105°). The Mann-Whitney test and the Kruskal-Wallis test were used to compare continuous variables and the chi-squared test and Fisher's exact test were used to compare categorical variables. Univariable and multivariable logistic regression analyses were used to identify the risk factors for morbidity and mortality.

Results: A total of 265 patients (149 men and median age of 59 years) were enrolled. Arterial position changes were detected in a total of 145 patients (54.7%) (99 patients (37%) with class I position changes and 46 patients (18%) with class II position changes) and were observed more often after extended resection and right-sided resection (P < 0.001). Major complications were seen in 94 patients (35%) and the rate of mortality was 15% (40 patients died). Post-hepatectomy liver failure (P = 0.030), major complications (P < 0.001), and mortality (P = 0.004) occurred more frequently in patients with class II position changes. In multivariable analysis, arterial position change was an independent risk factor for post-hepatectomy liver failure (OR 2.86 (95% c.i. 1.06 to 7.72); P = 0.038), major complications (OR 2.10 (95% c.i. 1.12 to 3.93); P = 0.020), and mortality (OR 2.39 (95% c.i. 1.03 to 5.56); P = 0.042).

Conclusion: Arterial position changes post-hepatectomy are observed in the majority of patients and are significantly related to postoperative morbidities and mortality.

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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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