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目的探讨肝良性疾病肝切除术术中出血的控制情况。方法回顾性总结空军总医院和解放军总医院1986-2010年955例连续性肝良性病变切除手术病例,对术中出血、输血情况,围术期情况及术后并发症等进行分析。结果本组病例数最多的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)。对872例患者进行肝功能Child评分,评估为A级者847例,占97.1%。术中失血≤200ml者596例(62.4%),200~400ml者122例(12.8%),400~1000ml者164例(17.2%),>1000ml者73例(7.6%)。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240.6±98.3min。术后住院天数14.0±8.2d。总的术后并发症发生率13.7%,围术期死亡率0.2%。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=0.003,OR=1.013)和血清白蛋白(ALB)值(P=0.035,OR=0.838),其中手术时间的延长为危险因素,ALB值的升高为保护因素。24年来肝良性疾病肝切除的手术时间、输血率、并发症发生率、术后住院时间均呈下降趋势(P<0.01)。结论肝切除术是治疗肝良性肿瘤安全有效的手段,重视围术期处理和手术技术创新,可有效控制肝良性病变切除术中出血量。
Objective To investigate the control of hemorrhage during liver resection for benign liver diseases. Methods A retrospective review of 955 consecutive cases of benign liver lesion resected from 1986 to 2010 in the Air Force General Hospital and People’s Liberation Army General Hospital was conducted to analyze intraoperative bleeding, transfusion, perioperative period and postoperative complications. Results The most number of cases in this group were hepatic hemangiomas and intrahepatic bile duct stones, accounting for 44.3% (423 cases) and 27.7% (265 cases) of all benign diseases respectively. Eighty-eight patients with liver function were scored as 847 grade A, accounting for 97.1%. There were 596 cases (62.4%) with intraoperative blood loss less than 200 ml, 122 cases (12.8%) with 200-400 ml, 164 cases (17.2%) with 400-1000 ml and 73 cases (7.6%) with> 1000 ml. 359 cases (37.6%) had transfusion of blood and 81 cases (8.5%) had autologous blood transfusion. The operation time was 240.6 ± 98.3min. The postoperative hospital stay was 14.0 ± 8.2 days. The overall incidence of postoperative complications was 13.7% and perioperative mortality was 0.2%. Multivariate logistic regression analysis showed that the independent factors associated with complications were operative time (P = 0.003, OR = 1.013) and serum albumin (ALB) (P = 0.035, OR = 0.838) As a risk factor, ALB value increased as a protective factor. The operation time, blood transfusion rate, complication rate and length of postoperative hospital stay in hepatic resection of liver benign disease showed a decreasing trend in 24 years (P <0.01). Conclusions Hepatectomy is a safe and effective method for the treatment of benign liver tumors. Emphasis on perioperative management and surgical technique innovation can effectively control the amount of bleeding during the resection of benign liver lesions.