联合肝分割和门静脉结扎分期肝切除术（ALPPS）与重复肝切除术相比，伤口并发症的风险因素--倾向得分匹配分析。

IF 2.1 3区医学 Q2 SURGERY Langenbeck's Archives of Surgery Pub Date : 2024-11-13 DOI:10.1007/s00423-024-03540-4

Elias Khajeh, Nastaran Sabetkish, Ali Ramouz, Alexander Werba, Rosa Klotz, Christoph W Michalski, Arianeb Mehrabi, Frank Pianka

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引用次数: 0

摘要

目的：充足的肝功能对细胞外基质生长、止血和伤口愈合至关重要。反复腹部手术是伤口并发症发生的一个已知风险因素。本研究旨在评估分期肝切除术（ALPPS）和重复肝切除术（RLR）与单肝切除术（SLR）相比，接受相关肝分割和门静脉结扎术的患者的这种高风险情况：采用倾向评分法将 2011 年至 2020 年间接受 ALPPS 的 40 例患者与接受 RLR 或 SLR 的患者（每组 40 例）进行平均匹配。比较术后结果并分析与伤口并发症相关的因素：结果：ALPPS 组术后伤口并发症发生率明显更高（P = 0.001）。三组之间的再手术率无明显差异（P = 0.143）。然而，ALPPS 组因伤口并发症而再次手术的比例高于 RLR 组和 SLR 组（分别为 17.5% 对 7.5% 和 5%）。ALPPS 组的住院时间明显更长（p = 0.033）。ALPPS 是术后伤口并发症的独立风险因素（OR = 8.55，95% CI：1.07-68.44，p = 0.043）。风险因素分析发现，年龄≥60岁（OR = 27.64，95% CI:3.09-246.75，p = 0.003）、体重指数≥30 kg/m2（OR = 30.21，95% CI:3.35-271.83，p = 0.002）和术后白蛋白水平低（OR = 168.41，95% CI:7.76-3651.18，p = 0.001）是肝脏大部切除术后伤口并发症的独立预测因素：结论：接受ALPPS和RLR手术的患者出现伤口并发症的风险很高。结论：接受ALPPS和RLR手术的患者出现伤口并发症的风险很高。年龄偏大、肥胖、既往腹部手术史以及术后白蛋白水平下降是伤口并发症的独立风险因素。

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Risk factors for wound complications after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) compared to repeated liver resection - a propensity score matching analysis.

Aim: Sufficient liver function is crucial in extracellular matrix growth, hemostasis, and wound healing. Repeated abdominal surgery is a known risk factor for the development of wound complications. This study aimed to evaluate this high-risk constellation in patients undergoing associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) and repeated liver resections (RLR) in comparison to single liver resection (SLR).

Method: Forty patients who underwent ALPPS between 2011 and 2020 were evenly matched with patients undergoing RLR or SLR (n = 40 per group) using propensity scores. Postoperative outcomes were compared and factors associated with wound complications were analyzed.

Results: Postoperative wound complications were significantly more frequent in ALPPS group (p = 0.001). The reoperation rate was not significantly different between the three groups (p = 0.143). However, surgical reintervention due to wound complications occurred more frequently in the ALPPS group in relation to RLR and SLR (17.5% vs. 7.5% and 5% respectively). Length of stay was significantly longer in the ALPPS group (p = 0.033). ALPPS was an independent risk factor for postoperative wound complication (OR = 8.55, 95% CI:1.07-68.44, p = 0.043). Risk factor analysis identified age ≥ 60 years (OR = 27.64, 95% CI:3.09-246.75, p = 0.003), BMI ≥ 30 kg/m² (OR = 30.21, 95% CI:3.35-271.83, p = 0.002), and low postoperative albumin levels (OR = 168.41, 95% CI:7.76-3651.18, p = 0.001) as independent predictors of postoperative wound complications after major liver resection.

Conclusion: Patients undergoing ALPPS and RLR are faced with a high risk of developing wound complications. Older age, obesity, a history of previous abdominal surgery, and a decreased postoperative albumin level were independent risk factors for wound complications.

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来源期刊

Langenbeck's Archives of Surgery 医学-外科

CiteScore

3.30

自引率

8.70%

发文量

342

审稿时长

4-8 weeks

期刊介绍： Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.